Abstract
Peritoneal carcinomatosis frequently occurs in advanced gastrointestinal and gynecological cancers. As factors such as poor drug uptake and distribution cause chemotherapy to be less effective, alternative therapies have been explored. Introduced in 2013, PIPAC (pressurized intraperitoneal aerosol chemotherapy) uses aerosolized chemotherapeutics sprayed into the patient’s peritoneal cavity using a laparoscopic approach. Despite the literature showing encouraging data regarding the tolerability and efficacy of PIPAC, there is a lack of articles on the role that imaging plays in selecting patients suitable for PIPAC. The aim of this study is to combine literature-based evidence and clinical experience to provide information able to support training radiologists, as well as experienced radiologists interested in innovative therapies.
Highlights
In advanced stages of gastrointestinal and gynecological cancers, peritoneal carcinomatosis frequently occurs due to disease progression and poor prognosis
New alternative therapies have been proposed with the ideal aim of safely delivering a highly selective dose of chemotherapy drug to peritoneal carcinomatosis (PC) lesions, using a minimally invasive platform
Patients are chosen for PIPAC based on clinical and radiological patterns; in particular, PIPAC is recommended for patients whose cancer has been stabilized by systemic chemotherapy but is not resectable due to extensive involvement, and who are not eligible for HIPEC and/or have chosen to stop IV chemotherapy, as well as patients who have developed resistance to systemic intravenous chemotherapy, or during first line treatment to reinforce IV chemotherapy in order to make an extensive peritoneal disease resectable [11]
Summary
New alternative therapies have been proposed with the ideal aim of safely delivering a highly selective dose of chemotherapy drug to peritoneal carcinomatosis (PC) lesions, using a minimally invasive platform. The recipients of these alternative approaches are patients with recurrent cancer and metachronous disease who do not benefit from palliative systemic chemotherapy or cannot undergo systemic chemotherapy. Reymond proposed PIPAC (pressurized intraperitoneal aerosol chemotherapy), a new intraperitoneal treatment approach. This procedure comprises of the spraying of aerosolized chemotherapeutics directly into the patient’s abdominal peritoneal cavity during abdominal laparoscopy. First reports seem to show that PIPAC is welltolerated, allowing increased locoregional delivery and tissue penetration of chemotherapy by hyper pressure, reducing the concentration of drugs used compared with those intravenously [1]
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