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abstract
Aim:
We aimed to assess the objective tumor response (OTR) to laparoscopic
pressurized intraperitoneal aerosol chemotherapy
(PIPAC) in women with peritoneal carcinomatosis
(PC).
Patients and Methods: We carried-out a retrospective cohort study
of
women with PC undergoing repeated courses of PIPAC
with 7.5 mg/m2 of cisplatin and 1.5 mg/m2 of
doxorubicin. OTR was defined as histological regression. Peritoneal
carcinomatosis index (PCI) improvement on video-laparoscopy
and ascites volume reduction were secondary
outcomes. Quality of life was assessed by the European Organization for
Research
& Treatment of Cancer Quality of Life
Questionnaire (EORTC QLQ)-30+3.
Results: A total of 252 PIPACs were
performed in 99
women with PC and ovarian (n=84), primary
peritoneal (n=6), cervical (n=3), endometrial (n=3), fallopian tube
(n=1), and breast
(n=1) cancer and pseudomyxoma peritonei (n=1).
Laparoscopic non-access rate was 17% (17/99). Fifty women had more than
one
PIPAC procedures, with an OTR of 76% (38/50) and
PCI improvement in 64% (32/50). Ascites volume significantly decreased
from
762±1170 ml to 167±456 ml (p=0.02). A high initial
Karnofsky Index was correlated with receiving more than one PIPAC
(p<0.0001)
and a high number of previous surgeries with
laparoscopic non-access (p=0.01). Twenty adverse events of Common
Terminology
Criteria for Adverse Events grade 3 or more were
noted. Absence of ascites (odds ratio=8.45, 95% confidence
interval=1.9-3.6;
p<0.0001), but not patient age, serum cancer
antigen-125, and Karnofsky Index independently predicted OTR. EORTC
QLQ-30+3
scores for global physical health, nausea/vomiting,
appetite loss, and constipation improved during therapy.
Conclusion:
PIPAC
with cisplatin and doxorubicin is an active
treatment in women with PC and preserves quality of life. Appropriate
patient
selection regarding performance status and the
number of prior surgeries is important.
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