Protocols, Complications, and Outcomes of Pressurized Intraperitoneal Aerosol Chemotherapy for Patients With Peritoneal Metastasis: A Systematic Review of the Literature.

Background: The use of pressurized intraperitoneal aerosol chemotherapy (PIPAC) is becoming more frequent for patients with unresectable peritoneal metastases. This systematic review explores the indications, protocols, feasibility, safety, oncological outcomes, patient reported outcomes and quality of life outcomes for patients being treated with PIPAC.

Methods: A review of PubMed, Embase and the Cochrane Library was undertaken to identify studies pertaining to patients undergoing treatment with PIPAC. Clinicopathological characteristics, treatment protocols, safety data, treatment response data and outcome data were extracted from relevant studies and included in the analysis.

Results: Data from 1980 patients undergoing 4454 PIPAC procedures for peritoneal metastases from a range of primary cancers was extracted. The treatment protocols identified were relatively homogenous across all studies. Grade 3/4 complications, grade 3/4 toxicity and procedure related mortality occurred infrequently. At least partial histological response was seen in 61.8% of patients. Overall survival for studies presenting data for mixed primary tumors ranged from 8 to 25 months. Quality of life and function were relatively stable throughout treatment.

Conclusions: PIPAC is a safe and feasible treatment option for patients with peritoneal metastases. Ongoing studies are required to evaluate how it compares to best option standard of care chemotherapy.