PIPAC experts meet in Egypt for an update on this chemotherapy technique

PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) delivers chemotherapy as a pressurised aerosol directly into the peritoneal cavity by laparoscopy. The pressure and the aerosol effect improve the drug's penetration into tissue compared with conventional systemic administration.

It is indicated for patients with unresectable peritoneal carcinomatosis in whom complete cytoreduction is not possible, as palliative treatment to control malignant ascites, as neoadjuvant treatment to shrink the tumour before surgery with HIPEC, and for recurrence after previous treatment.

PIPAC is minimally invasive (laparoscopy rather than laparotomy), can be repeated every 6 weeks and can be used in patients who are not candidates for major surgery. HIPEC is preferred when complete cytoreduction is possible, because it combines surgical resection with hyperthermic chemotherapy in a single operation.

The usual protocol involves sessions every 6 weeks. The total number is decided according to the response to treatment, the patient's tolerance and the aim of treatment: palliation, preoperative tumour reduction or ascites control. The decision is made by a multidisciplinary committee after each cycle.

The most commonly used are oxaliplatin, cisplatin and doxorubicin, alone or in combination depending on the primary tumour. The choice depends on the histological origin of the tumour and on the patient's tolerance. Protocols are reviewed regularly at specialist congresses.

It is used mainly in carcinomatosis of colorectal, ovarian, gastric and appendiceal origin and in peritoneal mesothelioma. The best-documented results are in gastric and ovarian carcinomatosis, where control of ascites and reduction of the Peritoneal Cancer Index (PCI) are the main indicators of response.

In selected cases, yes. By reducing the peritoneal tumour burden, PIPAC can lower the PCI to a level at which complete cytoreduction followed by HIPEC becomes feasible. This conversion strategy is planned from the start, with strict selection criteria and imaging follow-up.

The congress brought together PIPAC specialists from different countries to share optimised protocols, long-term results in different primary tumours and patient selection criteria. Our team presented its experience in gastric and ovarian carcinomatosis, with promising results in ascites control and survival.

Because it is a laparoscopic procedure, the general side effects are those of anaesthesia and minimally invasive surgery. Local effects depend on the drug used and on individual tolerance. Systemic toxicity is lower than with conventional intravenous chemotherapy, thanks to the regional route of administration.

The decision is made by a multidisciplinary committee that considers the PCI, the patient's general condition, the tumour histology and previous treatments. If complete cytoreduction is possible, HIPEC is preferred. If it is not, PIPAC is the first-line alternative for regional control of the disease.