Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in pancreatic cancer patients with peritoneal metastasis

Abstract

Introduction: The median survival in pancreatic cancer (PC) patients with synchronous peritoneal metastasis (PM) is six weeks, and the effect of palliative systemic chemotherapy is limited. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) has shown promising results in patients with PM of different origin, but data in patients with PM from PC are sparse. We present prospective data on PIPAC treatment in nine PC patients with PM. Methods: Between January 2016 and January 2018, PC patients with isolated PM were included. Objective response evaluation was based on the Peritoneal Regression Grading Score (PRGS) in repeated biopsies from PM. Survival data, prior chemotherapy, number and complications of PIPAC procedures were collected. Results: Nine patients (5M/4F, median age 62 years (range 46-72)) were included. Six patients had synchronous PM, whereas three patients developed PM after initial resection. Patients had received between 2 and 12 (median 9) cycles of systemic chemotherapy prior to inclusion. Twenty-four PIPAC procedures (median 2, range 1-5) were performed, without significant complications. The median survival was 11 months (range 8-25) after diagnosis of PM and 6 months (range 2-16) after the first PIPAC. Based on the PRGS score in six patients who received > 1 PIPAC, four patients responded and two had stable disease. One patient died before the second PIPAC (disease progression), two patients received no further PIPAC since PM could not be bioptically verified. Conclusions: PIPAC is safe in pancreatic cancer patients with peritoneal metastasis, and PIPAC may induce an objectively measureable treatment response.