Andrea Di Giorgio1, Carlo Alberto Schena1, Miriam Attalla El Halabieh1, Carlo Abatini1, Emanuele Vita2, Antonia Strippoli2, Frediano Inzani3, Elena Rodolfino4, Bruno Romanò5, Fabio Pacelli1, Stefano Rotolo6. 1. Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 2. Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 3. Institute of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 4. Department of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 5. Department of Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 6. Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy. Electronic address: stefano.rotolo@unipa.it.
Abstract
BACKGROUND: Few patients affected by gastric cancer peritoneal metastasis (GCPM) are offered locoregional treatment, despite several proof-of-efficacy trials. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged in recent years as a promising tool to control peritoneal carcinomatosis. The combination of PIPAC with systemic chemotherapy may offer a greater clinical benefit than standard treatment alone. METHODS: A single-center cohort of 28 consecutive patients affected by GCPM was scheduled for bidirectional treatment, comprising PIPAC and systemic chemotherapy, from September 2017 to September 2019. Data recorded included safety, efficacy and survival outcomes. Ascite volumes, the Peritoneal Cancer Index (PCI) and pathological response through the Peritoneal Regression Grading Score (PRGS) were compared in those patients who underwent more than one PIPAC procedure. RESULTS: Forty-six PIPAC procedures were administered, with a mean of 1.7 PIPAC procedures per patient. The median time to resume systemic chemotherapy after PIPAC was 6 days (range 4-7). Concerning safety, two grade 3-4 CTCAE (Common Terminology Criteria for Adverse Events v4.0) toxicity events and one intraoperative complication were recorded. Thirteen patients repeated PIPAC. A pathological response was recorded in 61.5% of patients (one with complete and seven with partial regression). The median overall survival was 12.3 months in the overall population and 15.0 months in patients undergoing more than one PIPAC procedure. CONCLUSIONS: A bidirectional approach for GCPM was feasible and safe, as the PIPAC procedure integrates well with several systemic chemotherapy regimens. The pathological response demonstrated the antitumoral efficacy of PIPAC. The proposed bidirectional approach may be further investigated in the first-line treatment of metastatic gastric cancer.
BACKGROUND: Few patients affected by gastric cancer peritoneal metastasis (GCPM) are offered locoregional treatment, despite several proof-of-efficacy trials. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged in recent years as a promising tool to control peritoneal carcinomatosis. The combination of PIPAC with systemic chemotherapy may offer a greater clinical benefit than standard treatment alone. METHODS: A single-center cohort of 28 consecutive patients affected by GCPM was scheduled for bidirectional treatment, comprising PIPAC and systemic chemotherapy, from September 2017 to September 2019. Data recorded included safety, efficacy and survival outcomes. Ascite volumes, the Peritoneal Cancer Index (PCI) and pathological response through the Peritoneal Regression Grading Score (PRGS) were compared in those patients who underwent more than one PIPAC procedure. RESULTS: Forty-six PIPAC procedures were administered, with a mean of 1.7 PIPAC procedures per patient. The median time to resume systemic chemotherapy after PIPAC was 6 days (range 4-7). Concerning safety, two grade 3-4 CTCAE (Common Terminology Criteria for Adverse Events v4.0) toxicity events and one intraoperative complication were recorded. Thirteen patients repeated PIPAC. A pathological response was recorded in 61.5% of patients (one with complete and seven with partial regression). The median overall survival was 12.3 months in the overall population and 15.0 months in patients undergoing more than one PIPAC procedure. CONCLUSIONS: A bidirectional approach for GCPM was feasible and safe, as the PIPAC procedure integrates well with several systemic chemotherapy regimens. The pathological response demonstrated the antitumoral efficacy of PIPAC. The proposed bidirectional approach may be further investigated in the first-line treatment of metastatic gastric cancer.
Authors: Rémy Sindayigaya; Can Dogan; Cédric Remy Demtröder; Britta Fischer; Elias Karam; Jonathan Robin Buggisch; Clemens B Tempfer; Thierry Lecomte; Mehdi Ouaissi; Urs Giger-Pabst Journal: Ann Surg Oncol Date: 2021-10-05 Impact factor: 5.344
Authors: Stefano Rotolo; Andrea Di Giorgio; Marco Cintoni; Emanuele Rinninella; Marta Palombaro; Gabriele Pulcini; Carlo Alberto Schena; Vito Chiantera; Giuseppe Vizzielli; Antonio Gasbarrini; Fabio Pacelli; Maria Cristina Mele Journal: Pleura Peritoneum Date: 2022-03-01
Authors: Laura Toussaint; Hugo Teixeira Farinha; Jean-Luc Barras; Nicolas Demartines; Christine Sempoux; Martin Hübner Journal: Pleura Peritoneum Date: 2021-07-15
Authors: Michel Adamina; Maxime Warlaumont; Martin D Berger; Silvio Däster; Raphaël Delaloye; Antonia Digklia; Beat Gloor; Ralph Fritsch; Dieter Koeberle; Thibaud Koessler; Kuno Lehmann; Phaedra Müller; Ralph Peterli; Frédéric Ris; Thomas Steffen; Christian Stefan Weisshaupt; Martin Hübner Journal: Cancers (Basel) Date: 2022-09-01 Impact factor: 6.575