Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for the treatment of malignant mesothelioma

Autor: Thorsten O. Götze, Cedric Demtröder, Thomas Albert Falkenstein, M. Ouaissi, Urs Giger-Pabst, Clemens B. Tempfer, Günther A. Rezniczek
Rok vydání: 2018
Předmět:
Adult
Male
Mesothelioma
Cancer Research
medicine.medical_specialty
Lung Neoplasms
PITAC
medicine.medical_treatment
PIPAC
lcsh:RC254-282
03 medical and health sciences
0302 clinical medicine
Antineoplastic Combined Chemotherapy Protocols
Peritoneal
Genetics
medicine
Malignant pleural effusion
Humans
Infusions
Parenteral
Tumor regression
Adverse effect
Aged
Retrospective Studies
Tumor Regression Grade
Aged
80 and over
Chemotherapy
business.industry
Mesothelioma
Malignant
Retrospective cohort study
Middle Aged
medicine.disease
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Magnetic Resonance Imaging
Surgery
Pleural Effusion
Malignant
Pemetrexed
Treatment Outcome
Oncology
Thoracal
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Female
business
Tomography
X-Ray Computed
Abdominal surgery
medicine.drug
Research Article
Zdroj: BMC Cancer
BMC Cancer, Vol 18, Iss 1, Pp 1-9 (2018)
ISSN: 1471-2407
Popis: Background Patients with recurrent malignant epithelioid mesothelioma (MM) after surgery and standard chemotherapy with cisplatin and pemetrexed have limited treatment options. Methods We performed a retrospective cohort study of patients with recurrent MM undergoing Pressurized IntraPeritoneal/Thoracal Aerosol Chemotherapy (PIPAC/PITAC) with doxorubicin 1.5 mg/m2 and cisplatin 7.5 mg/m2. Data were retrospectively collected in a prospective registry of patients undergoing PIPAC/PITAC. Study outcomes were microscopic tumor regression grade (TRG), survival and adverse events (v4.0 CTCAE). Results A total of 29 patients (m/f = 17/12) with MM with a mean age of 62.4 (range: 42 to 84) years were analyzed. A total of 74 PIPAC and 5 PITAC procedures were performed. The mean number of PIPAC applications was 2.5 (range: 0 to 10) per patient. Twenty patients (69%) had > 2 PIPAC procedure and were eligible for TRG analysis. TRG 1 to 4 was observed in 75% (15/20) of patients. Major regression (TRG 3) or complete regression (TRG 4) was observed in 20% and 10%, respectively. PIPAC induced significant tumor regression in 51.7% (15/29) of patients with a cumulative effect after repetitive PIPACs (PIPAC #1 vs. PIPAC #2: p = 0.001; PIPAC #1 vs. PIPAC #3: p = 0.001; PIPAC #1 vs. PIPAC #4: p = 0.001). Postoperative CTCAE grade 4 complications were observed in two patients (6.9%) who had cytoreductive surgery (CC2) and intraoperative PIPAC. One patient (3.4%) died due to postoperative kidney insufficiency. After a follow up of 14.4 (95% CI: 8.1 to 20.7) months after the last PIPAC/PITAC application, median overall survival was 26.6 (95% CI: 9.5 to 43.7) months (from the first application). Conclusion After prior abdominal surgery and systemic chemotherapy, repetitive PIPAC applications are feasible and safe for patients with end-stage MM. Furthermore, PIPAC induces significant histological regression of malignant mesothelioma in the majority of patients. PITAC is feasible, but its safety and efficacy to control malignant pleural effusion remain unclear. Electronic supplementary material The online version of this article (10.1186/s12885-018-4363-0) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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