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2022-RA-1064-ESGO Unresectable peritoneal metastases from stage III ovarian cancer treated with bidirectional approach of Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) and systemic chemotherapy may lead to secondary complete cytoreductive surgery: a pilot study
  1. Amaniel Kefleyesus1,
  2. Vahan Kepenekian1,
  3. Isabelle Bonnefoy2,
  4. Julien Peron3,
  5. Benoit You3,
  6. Olivier Glehen1 and
  7. Naoual Bakrin1
  1. 1Department of Surgical Oncology, Lyon University Hospital, Pierre-Bénite, France
  2. 2Department of Clinical Research, Lyon University Hospital, Pierre-Bénite, France
  3. 3Department of Medical Oncology, Lyon University Hospital, Pierre-Bénite, France


Introduction/Background Ovarian cancer (OC) is the leading cause of death among women diagnosed with gynaecological cancer. The natural course of the disease is progression to peritoneal metastases (PM), a high rate of platinum chemoresistance, and a low overall survival rate, with no effect of a screening system. This background explains the interest in locoregional treatment of peritoneal disease which has shown a benefit in terms of overall and progression-free survival for selected patients treated with complete cytoreductive surgery. This pilot study aimed to investigate the feasibility and safety of secondary complete cytoreductive surgery after a bidirectional treatment of Pressurized IntraPeritoneal Chemotherapy (PIPAC) and systemic chemotherapy.

Methodology A retrospective single-tertiary-canter pilot study with unresectable stage III serous ovarian cancer patients treated by induction chemotherapy based on carboplatin and paclitaxel combined with a minimum of 3 PIPAC, between May 01, 2019 and October 30, 2021. All patients had a diagnostic laparoscopic exploration. After 3 cycles of chemotherapy PIPAC was initiated if unresectable disease without extraperitoneal metastases including loco-regional lymphadenopathy. Resectable disease after 3 cycles of bidirectional treatment was eligible for CRS. Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) was done after complete CRS without the residual disease.

Results All patients completed at least 3 PIPAC (n=7, 89%) in a bidirectional approach, and one patient had completed 4 PIPAC. Most patients (n=6, 75%) were secondarily treated by CRS-HIPEC. In two patients the disease remained unresectable and had to be changed for second-line chemotherapy. Median PCI during surgery was 17 (IQR 2.3). The postoperative course was uneventful regarding severe complications.

Conclusion PIPAC is safe and feasible in a neo-adjuvant intent for unresectable ovarian cancer patients and may lead to complete CRS.

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