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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...

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Autores principales: Daniel, Sara K., Sun, Beatrice J., Lee, Byrne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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.
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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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