Feasibility, efficacy and safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC) for hepatobiliary and pancreatic cancers with peritoneal metastases: A systematic review.
Hepato-pancreato-biliary (HPB) cancers frequently develop peritoneal metastases, signalling a poor prognosis and severely limiting the efficacy of systemic treatments. This review evaluates the feasibility, efficacy, and safety of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) for these malignancies.
We conducted a systematic review in accordance with the PRISMA guidelines. A comprehensive, structured search strategy was applied to PubMed, Scopus, and Web of Science to identify eligible non-interventional studies involving adult patients with HPB cancers and peritoneal metastases undergoing PIPAC.
Ten studies encompassing 332 patients were included. PIPAC was feasible, with non-access rates ranging from 0% to 11.8%. Patients completed a mean of 1.3-1.8 cycles for hepatobiliary and 2.1-3 cycles for pancreatic cancers. Median overall survival ranged from 85 days to 15.1 months for hepatobiliary malignancies, and 8.5 to 12.7 months for pancreatic cancers. The procedure demonstrated a high safety profile, with no severe postoperative systemic toxicities (Common Terminology Criteria for Adverse Events grade ≥3) reported.
PIPAC appears to be a safe, feasible and potentially efficacious intervention for HPB peritoneal metastases. However, current evidence remains heterogeneous, necessitating standardised, prospective trials to clearly define its clinical role.
We conducted a systematic review in accordance with the PRISMA guidelines. A comprehensive, structured search strategy was applied to PubMed, Scopus, and Web of Science to identify eligible non-interventional studies involving adult patients with HPB cancers and peritoneal metastases undergoing PIPAC.
Ten studies encompassing 332 patients were included. PIPAC was feasible, with non-access rates ranging from 0% to 11.8%. Patients completed a mean of 1.3-1.8 cycles for hepatobiliary and 2.1-3 cycles for pancreatic cancers. Median overall survival ranged from 85 days to 15.1 months for hepatobiliary malignancies, and 8.5 to 12.7 months for pancreatic cancers. The procedure demonstrated a high safety profile, with no severe postoperative systemic toxicities (Common Terminology Criteria for Adverse Events grade ≥3) reported.
PIPAC appears to be a safe, feasible and potentially efficacious intervention for HPB peritoneal metastases. However, current evidence remains heterogeneous, necessitating standardised, prospective trials to clearly define its clinical role.
Authors
Martins Martins, Rebelo Rebelo, Nogueiro Nogueiro, Fernandes Fernandes, Mortensen Mortensen, Ferreira-da-Silva Ferreira-da-Silva, Bouça-Machado Bouça-Machado
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