Geburtshilfe Frauenheilkd 2015; 75 - PO3_1
DOI: 10.1055/s-0035-1560004

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) with cisplatin and doxorubicin in 99 women with gynecologic malignancies and peritoneal carcinomatosis: a retrospective cohort study

C Tempfer 1, G Rezniczek 1, M Tsitas 1, P Ende 1, W Solass 2, C Demtroeder 3, MA Reymond 3
  • 1Department of Obstetrics and Gynecology, Ruhr-Universität Bochum – Bochum (Germany)
  • 2Institute of Pathology, Medical School Hannover – Hannover (Germany)
  • 3Department of Surgery, Ruhr-Universität Bochum – Bochum (Germany)

Objective: To assess the objective tumor response (OTR) of laparoscopic pressurized intraperitoneal aerosol chemotherapy (PIPAC) in women with gynecologic malignancies and peritoneal carcinomatosis (PC).

Methods: Retrospective cohort study using registry data of women with repeated courses q 28 – 42 days of PIPAC with cisplatin 7.5 mg/m2 and doxorubicin 1.5 mg/m2. OTR was defined as histological regression. Peritoneal carcinomatosis index (PCI) improvement on video-laparoscopy and ascites volume reduction were secondary outcomes. Quality of life was assessed using the EORTC QLQ-30(+3) questionnaire.

Results: 252 PIPAC procedures were performed in 99 women with PC and ovarian cancer (n = 84), fallopian tube cancer (n = 1), primary peritoneal cancer (n = 6), pseudomyxoma peritonei (n = 1), cervical cancer (n = 3), endometrial cancer (n = 3), and breast cancer (n = 1). Laparoscopic non-access rate was 17% (17/99). 50 women had > 1 PIPAC procedures. Among these women, OTR was noted in 76% (38/50) and PCI improvement on repeated video-laparoscopy in 64% (32/50). Median ascites volume decreased significantly during therapy from 762 ± 1170 ml to 167 ± 456 ml (p = 0.02). A high initial Karnofsky Index was correlated with receiving > 1 PIPACs (p < 0.0001). A high number of previous surgeries was correlated with laparoscopic non-access (p = 0.01). 20 adverse events CTCAE grade = 3 were noted. Perioperative mortality was 0%. In a multivariable regression analysis with OTR as the dependent variable, absence of ascites (odds ratio [OR] 8.45; 95% confidence interval [CI] 1.9 – 3.6; p < 0.0001), but not patient age, serum CA-125, and Karnofsky Index independently predicted OTR. EORTC QLQ-30(+3) scores for global physical health, nausea/vomiting, appetite loss, constipation, physical, role, emotional, and social functioning improved during therapy.

Conclusion: PIPAC with cisplatin and doxorubicin is an active treatment in women with gynecologic malignancies and PC and preserves quality of life. Appropriate patient selection regarding performance status and the number of prior surgeries is important.