Article Text
Abstract
Introduction PIPAC has shown improved objective response rate with improved quality of life in combination with IV chemotherapy when compared to IV chemotherapy alone in salvage situations.
Methods Patients with primarily inoperable advanced epithelial ovarian cancer who could not undergo CRS-HIPEC were challenged with bidirectional PIPAC & IV chemotheraphy as a salvage situation after discussion in MDT. Patients who subsequently underwent CRS-HIPEC were analysed to study their clinical characteristics, extent of disease and peri-operative outcomes. PIPAC was given with Cisplatin 15mg/m2 and doxorubicin 3mg/m2. Intravenous chemotheraphy was given within one week of PIPAC. Each cycle was repeated once in 4-5 weeks.
Results 120 PIPAC applications were done in 45 patients. 30 patients received 3 cycles of PIPAC with IV chemotheraphy given within one week of PIPAC. Out of 45 patients 28 underwent CRS-HIPEC subsequently. Mean age 54.5±10.74, PCI 15±5, duration of surgery 9.6±1.2 hrs. The mean drop in PCI who completed 3 PIPAC with IV chemotheraphy was 5±0.8. Out of 45 patients nearly 60% showed PRGS 1, 25% PRGS 2 and 15% PRGS 3. 52.4% had total peritonectomy, 12.7% had multivisceral resection, 55.8% had one bowel resections and stoma rate was 3.5%. Overall G3-G5 morbidity was 25.4% with major ones being post-operative intra-abdominal collection (21.8%), electrolyte imbalance (16.4%), pulmonary (16.4%) followed by hematological (12.7%). The 30 day mortality was 3.8%.
Conclusion/Implications Neo-adjuvant PIPAC with Intravenous chemotheraphy might be a promising combination for inducing good response rates in advanced epithelial ovarian carcinoma. CRS-HIPEC following neo-adjuvant PIPAC + IV chemotheraphy is safe, feasible and tolerable.