Pressurized intraperitoneal aerosol chemotherapy (PIPAC) with cisplatin and doxorubicin in a woman with pseudomyxoma peritonei: A case report

Clemens B Tempfer, Wiebke Solass, Bernd Buerkle, Marc-André Reymond, Clemens B Tempfer, Wiebke Solass, Bernd Buerkle, Marc-André Reymond

Abstract

•This is the first report of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in a woman with pseudomyxoma peritonei.•PIPAC achieved clinical and histological disease remission.•PIPAC with cisplatin and doxorubicin may be effective in pseudomyxoma peritonei.

Keywords: Cisplatin; Doxorubicin; High pressure; Intraabdominal; Intraperitoneal chemotherapy; Pseudomyxoma peritonei.

Figures

Fig. 1
Fig. 1
Intraoperative findings (macroscopy) before PIPAC therapy (panels a1, a2) and 6 weeks after PIPAC #2 (panels b1, b2). After therapy, mucus had largely disappeared from the abdomen, and ascites had disappeared. Nodular sclerosis of peritoneal nodules was observed, as well as reticular scarring of the visceral and the parietal peritoneum. Total peritoneal carcinomatosis index (PCI) remained constant, since quantitative parameters (the number and the size of tumor nodes) did not change significantly, although the qualitative aspect of tumor nodes was modified after therapy.
Fig. 2
Fig. 2
Intraoperative findings (microscopy) before PIPAC #1 (panel a1) and 6 weeks after PIPAC #2 (panel a2) confirming pseudomyxoma peritonei (PMP). Before PIPAC, histology showed peritoneal infiltration by a poorly differentiated adenocarcinoma with extracellular mucus deposits with isolated tumor cells in 4/5 biopsies. After therapy, 2/3 biopsies were tumor free, showing fibrosis with acute and chronic inflammation. The third biopsy revealed localized peritoneal infiltration by a highly regressive mucinous adenocarcinoma (panel a2, inset *).

References

    1. Baratti D., Kusamura S., Nonaka D., Langer M., Andreola S., Favaro M., Gavazzi C., Laterza B., Deraco M. Pseudomyxoma peritonei: clinical pathological and biological prognostic factors in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) Ann. Surg. Oncol. 2008;15(2):526–534.
    1. Buell-Gutbrod R., Gwin K. Pathologic diagnosis, origin, and natural history of pseudomyxoma peritonei. Am. Soc. Clin. Oncol. Educ. Book. 2013;221–5
    1. Common Terminology Criteria for Adverse Events (CTCAE) version 4.0; published: May 28, 2009 (v4.03: June 14, 2010); U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute
    1. Dedrick R.L., Flessner M.F. Pharmacokinetic problems in peritoneal drug administration: tissue penetration and surface exposure. J. Natl. Cancer Inst. 1997;89:480–487.
    1. Leen S.L., Singh N. Pathology of primary and metastatic mucinous ovarian neoplasms. J. Clin. Pathol. 2012;65(7):591–595.
    1. Mazzei M.A., Khader L., Cirigliano A., Cioffi Squitieri N., Guerrini S., Forzoni B., Marrelli D., Roviello F., Mazzei F.G., Volterrani L. Accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) Abdom. Imaging. 2013;38(6):1422–1430.
    1. McBride K., McFadden D., Osler T. Improved survival of patients with pseudomyxoma peritonei receiving intraperitoneal chemotherapy with cytoreductive surgery: a systematic review and meta-analysis. J. Surg. Res. 2013;183(1):246–252.
    1. Reymond M.A., Hu B., Garcia A. Feasibility of therapeutic pneumoperitoneum in a large animal model using a microvaporisator. Surg. Endosc. 2000;14:51–55.
    1. Saxena A., Yan T.D., Chua T.C., Morris D.L. Critical assessment of risk factors for complications after cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei. Ann. Surg. Oncol. 2010;17(5):1291–1301.
    1. Smeenk R.M., van Velthuysen M.L., Verwaal V.J., Zoetmulder F.A. Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur. J. Surg. Oncol. 2008;34(2):196–201.
    1. Solass W., Herbette A., Schwarz T., Hetzel A., Sun J.S., Dutreix M., Reymond M.A. Therapeutic approach of human peritoneal carcinomatosis with Dbait in combination with capnoperitoneum: proof of concept. Surg. Endosc. 2012;26(3):847–852.
    1. Solass W., Giger-Pabst U., Zieren J., Reymond M.A. Pressurized intraperitoneal aerosol chemotherapy (PIPAC): occupational health and safety aspects. Ann. Surg. Oncol. 2013;20(11):3504–3511.
    1. Solass W., Kerb R., Muerdter T., Giger U., Strumberg D., Tempfer C., Zieren J., Schwab M., Reymond Intraperitoneal chemotherapy of peritoneal carcinomatosis using pressurized aerosol as an alternative to liquid solution: first evidence for efficacy. Ann. Surg. Oncol. 2014;21(2):553–559.
    1. Tempfer C.B., Celik I., Solass W., Buerkle B., Pabst U.G., Zieren J., Strumberg D., Reymond M.A. Activity of pressurized intraperitoneal aerosol chemotherapy (PIPAC) with cisplatin and doxorubicin in women with recurrent, platinum-resistant ovarian cancer: preliminary clinical experience. Gynecol. Oncol. 2014;132(2):307–311.
    1. Varona J.F., Guerra J.M., Salamanca J., Colina F., Lopez G., Morales M. Pseudomyxoma peritonei: a clinicopathologic analysis and follow-up of 21 patients. Hepatogastroenterology. 2005;52(63):812–816.

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