Abstract
To evaluate the technical feasibility and homogeneity of drug distribution of pressurized intraperitoneal aerosol chemotherapy (PIPAC) based on a novel process of intraperitoneal drug application (multidirectional aerosolization). This was an in vivo experimental study in pigs. A single-port device was manufactured at the smallest diameter possible for multidirectional aerosolization of the chemotherapeutic drug under positive intraperitoneal pressure. Four domestic pigs were used in the study, one control animal that received multidirectional microjets of 9 mL/sec for 30 min and three animals that received multidirectional aerosolization (pig 02: 9 mL/sec for 30 min; pigs 03 and 04: 3 mL/sec for 15 min). Aerosolized silver nitrate solution was applied for anatomopathological evaluation of intraperitoneal drug distribution. Injection time was able to maintain the pneumoperitoneum pressure below 20 mmHg. The rate of moderate silver nitrate staining was 45.4% for pig 01, 36.3% for pig 02, 36.3% for pig 03, and 72.7% for pig 04. Intra-abdominal drug distribution had a broad pattern, especially in animals exposed to the drug for 30 min. Our sample of only four animals was not large enough to demonstrate an association between aerosolization and a higher silver nitrate concentration in the stained abdominal regions.
Highlights
Peritoneal carcinomatosis is considered to be an advanced neoplastic disease for which the available treatments do not significantly alter the fatal outcome of the disease
Direct contact of the chemotherapeutic agent in the peritoneal cavity with the metastatic nodules has a higher bioactivity in the tumors than does systemic chemotherapy, demonstrating an advantage of intraperitoneal application for the treatment of carcinomatosis[3]
In pig 01, the samples obtained from all 11 abdominal regions showed evidence of silver nitrate, indicating that the substance was distributed throughout the peritoneal cavity
Summary
Peritoneal carcinomatosis is considered to be an advanced neoplastic disease for which the available treatments do not significantly alter the fatal outcome of the disease. A better understanding of the condition as part of the process of cancer spread and as a disease limited to a single ‘organ’ – the peritoneum – has changed the forms of treatment of the disease[1]. This new concept, developed from the studies of Dr Paul H. Direct contact of the chemotherapeutic agent in the peritoneal cavity with the metastatic nodules has a higher bioactivity in the tumors than does systemic chemotherapy, demonstrating an advantage of intraperitoneal application for the treatment of carcinomatosis[3]
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