Recycling of residual liquid drug formation following pressurized intra-peritoneal aerosol chemotherapy (PIPAC).

Abstract

e14215 Background: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is becoming an increasingly widespread approach in which intra-peritoneal chemotherapy (IPC) is delivered in the shape of a chemoaerosol formed by an aerosol creating device. Disadvantages of current PIPAC applications include nearly instant liquid drug accumulation in the recto-uterine pouch. This study aims to investigate the feasibility of respraying the accumulated liquid to prevent local cytotoxicity and tissue trauma as well as to possibly adjust drug concentrations and improve both distribution patterns and penetration levels. Methods: A well-established, previously described postmortem swine model was used. 200ml of doxorubicin solution were aerosolized within the abdominal cavity at a pressure of 12 mm Hg C02 and 37° degrees Celsius. A suction tube was placed in the recto-uterine pouch and accumulating liquid doxorubicin solution following aerosol formation was collected and recycled in consecutive PIPAC repetitions. PIPAC repetitions were performed by using only the remaining liquid drug within the pouch. Consecutive residual volumes within the recto-uterine pouch were measured, as well as tissue penetration rates at different locations of the peritoneal wall. Results: Liquid formation was continuously reduced with each consecutive spray cycle. Tissue penetration rates were significantly higher following the recycling process (p < 0.05). Drug distribution pattern showed a significant improvement following the recycling process vs. after initial aerosol formation (p < 0.05). Conclusions: Respraying the accumulated liquid drug in the recto-uterine pouch is both feasible and important to eliminate liquid accumulation following PIPAC application. Preliminary data gathered in this study suggest that such a recycling process both improves drug distribution and increases penetration levels. However, recycling might also increase the technical complexity of the entire applicational procedure.