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Peritoneal carcinomatosis (PC) refers to intraperitoneal dissemination of any form of carcinoma. Most frequent conditions are ovarian, gastric, colorectal and patients with peritoneal mesothelioma. Median overall survival in patients with PC after systemic chemotherapy ranges from 6 to 12, 12 to 16 and 14 to 24 months in gastric, colorectal and ovarian origin respectively.
Selected patients with PC from the aforementioned origins are usually treated with cytoreductive surgery (CRS) with or without hyperthermic chemotherapy delivered directly into the peritoneum (HIPEC). Pressurised intraperitoneal aerosol chemotherapy (PIPAC) has been proposed as an alternative mode for intraperitoneal drug delivery. PIPAC advantages include an increased intratumoral drug concentration, low systemic toxicity, a homogeneous distribution, better tolerance, and the possibility of repeating treatment through minimally invasive access.
For patients with unresectable peritoneal metastases, systemic chemotherapy remains the standard of care. For its characteristics (low blood flow, interstitial fibrosis and plasma-peritoneal barrier), this chemotherapy presents weak penetration which results in relative chemoresistance and non-negligible toxicity. Currently, PIPAC is considered an alternative therapy only in these palliative cases, aiming to improve tumor response and increase the patient’s quality of life.
This video will focus on PIPAC outcomes and the current evidence-based data.