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PIPAC for Gastrointestinal Malignancies
The peritoneum is a common site of metastases for gastrointestinal tumors that predicts a poor outcome. In addition to decreased survival, peritoneal metastases (PMs) can significantly impact quality of life from the resulting ascites and bowel obstructions. The peritoneum has been a target for regi...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10650315/ https://www.ncbi.nlm.nih.gov/pubmed/37959264 http://dx.doi.org/10.3390/jcm12216799 |
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author | Daniel, Sara K. Sun, Beatrice J. Lee, Byrne |
author_facet | Daniel, Sara K. Sun, Beatrice J. Lee, Byrne |
author_sort | Daniel, Sara K. |
collection | PubMed |
description | The peritoneum is a common site of metastases for gastrointestinal tumors that predicts a poor outcome. In addition to decreased survival, peritoneal metastases (PMs) can significantly impact quality of life from the resulting ascites and bowel obstructions. The peritoneum has been a target for regional therapies due to the unique properties of the blood–peritoneum barrier. Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) have become accepted treatments for limited-volume peritoneal disease in appendiceal, ovarian, and colorectal malignancies, but there are limitations. Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) improves drug distribution and tissue penetration, allowing for a minimally invasive application for patients who are not CRS/HIPEC candidates based on high disease burden. PIPAC is an emerging treatment that may convert the patient to resectable disease, and may increase survival without major morbidity, as indicated by many small studies. In this review, we discuss the rationale and benefits of PIPAC, as well as sentinel papers describing its application for gastric, colorectal, appendiceal, and pancreatobiliary PMs. While no PIPAC device has yet met FDA approval, we discuss next steps needed to incorporate PIPAC into neoadjuvant/adjuvant treatment paradigms, as well as palliative settings. Data on active clinical trials using PIPAC are provided. |
format | Online Article Text |
id | pubmed-10650315 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-106503152023-10-27 PIPAC for Gastrointestinal Malignancies Daniel, Sara K. Sun, Beatrice J. Lee, Byrne J Clin Med Review The peritoneum is a common site of metastases for gastrointestinal tumors that predicts a poor outcome. In addition to decreased survival, peritoneal metastases (PMs) can significantly impact quality of life from the resulting ascites and bowel obstructions. The peritoneum has been a target for regional therapies due to the unique properties of the blood–peritoneum barrier. Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) have become accepted treatments for limited-volume peritoneal disease in appendiceal, ovarian, and colorectal malignancies, but there are limitations. Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) improves drug distribution and tissue penetration, allowing for a minimally invasive application for patients who are not CRS/HIPEC candidates based on high disease burden. PIPAC is an emerging treatment that may convert the patient to resectable disease, and may increase survival without major morbidity, as indicated by many small studies. In this review, we discuss the rationale and benefits of PIPAC, as well as sentinel papers describing its application for gastric, colorectal, appendiceal, and pancreatobiliary PMs. While no PIPAC device has yet met FDA approval, we discuss next steps needed to incorporate PIPAC into neoadjuvant/adjuvant treatment paradigms, as well as palliative settings. Data on active clinical trials using PIPAC are provided. MDPI 2023-10-27 /pmc/articles/PMC10650315/ /pubmed/37959264 http://dx.doi.org/10.3390/jcm12216799 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Daniel, Sara K. Sun, Beatrice J. Lee, Byrne PIPAC for Gastrointestinal Malignancies |
title | PIPAC for Gastrointestinal Malignancies |
title_full | PIPAC for Gastrointestinal Malignancies |
title_fullStr | PIPAC for Gastrointestinal Malignancies |
title_full_unstemmed | PIPAC for Gastrointestinal Malignancies |
title_short | PIPAC for Gastrointestinal Malignancies |
title_sort | pipac for gastrointestinal malignancies |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10650315/ https://www.ncbi.nlm.nih.gov/pubmed/37959264 http://dx.doi.org/10.3390/jcm12216799 |
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