Consensus guidelines for pressurized intraperitoneal aerosol chemotherapy: Technical aspects and treatment protocols.
Indications
PIPAC
Safety
Technique
Treatment protocol
Journal
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
11
05
2021
revised:
22
10
2021
accepted:
28
10
2021
pubmed:
18
11
2021
medline:
13
4
2022
entrez:
17
11
2021
Statut:
ppublish
Résumé
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is increasingly used to treat patients with peritoneal cancer. A recent survey demonstrated considerable diversification of current practice of PIPAC raising issues of concern also regarding safety and efficacy. The study aim was to reach consensus on best practice of PIPAC treatment. Current practice was critically discussed during an expert meeting and the available evidence was scrutinized to elaborate a 33-item closed-ended questionnaire. All active PIPAC centers were then invited to participate in an online two-round Delphi process with 3 reminders at least. Consensus was defined a priori as >70% agreement for a minimal response rate of 70%. Forty-nine out of 57 invited PIPAC centers participated in Delphi 1 and 2 (86%). Overall, there was agreement for 21/33 items. Consensus was reached for important aspects like advanced OR ventilation system (91.8%), remote monitoring (95.9%), use of the PRGS (85.7%) and use of a safety checklist (98%). The drug regimens oxaliplatin (87.8%) and cisplatin/doxorubicin (81.6%) were both confirmed by the expert panel. Important controversies included number and location of Biopsies during repeated PIPAC and the combination of PIPAC with additional surgical procedures. This consensus statement aims to allow for safe and efficacious PIPAC treatment and to facilitate multi-center analyses of the results. Additional preclinical and clinical studies are needed to resolve the remaining controversies.
Sections du résumé
BACKGROUND
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is increasingly used to treat patients with peritoneal cancer. A recent survey demonstrated considerable diversification of current practice of PIPAC raising issues of concern also regarding safety and efficacy. The study aim was to reach consensus on best practice of PIPAC treatment.
METHODS
Current practice was critically discussed during an expert meeting and the available evidence was scrutinized to elaborate a 33-item closed-ended questionnaire. All active PIPAC centers were then invited to participate in an online two-round Delphi process with 3 reminders at least. Consensus was defined a priori as >70% agreement for a minimal response rate of 70%.
RESULTS
Forty-nine out of 57 invited PIPAC centers participated in Delphi 1 and 2 (86%). Overall, there was agreement for 21/33 items. Consensus was reached for important aspects like advanced OR ventilation system (91.8%), remote monitoring (95.9%), use of the PRGS (85.7%) and use of a safety checklist (98%). The drug regimens oxaliplatin (87.8%) and cisplatin/doxorubicin (81.6%) were both confirmed by the expert panel. Important controversies included number and location of Biopsies during repeated PIPAC and the combination of PIPAC with additional surgical procedures.
CONCLUSION
This consensus statement aims to allow for safe and efficacious PIPAC treatment and to facilitate multi-center analyses of the results. Additional preclinical and clinical studies are needed to resolve the remaining controversies.
Identifiants
pubmed: 34785087
pii: S0748-7983(21)00778-2
doi: 10.1016/j.ejso.2021.10.028
pii:
doi:
Substances chimiques
Aerosols
0
Oxaliplatin
04ZR38536J
Cisplatin
Q20Q21Q62J
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
789-794Investigateurs
Julio Abba
(J)
Adnane Afifi
(A)
Michael Bau Mortensen
(MB)
Aditi Bhatt
(A)
Andreas Brandl
(A)
Wim Ceelen
(W)
Julien Coget
(J)
Thomas Courvoiser
(T)
Ignace H de Hingh
(IH)
Jean-Baptiste Delhorme
(JB)
Andrea di Giorgio
(A)
Frederic Dumont
(F)
Cecilia Escayola
(C)
Clarisse Eveno
(C)
Anne-Cécile Ezanno
(AC)
Johan Gagnière
(J)
Julio Galindo
(J)
Torben Glatz
(T)
Olivier Glehen
(O)
Tarkan Jäger
(T)
Vahan Kepenekian
(V)
Vladimir M Khomyakov
(VM)
Konstantinos Kothonidis
(K)
Kuno Lehmann
(K)
Craig Lynch
(C)
Sanket Mehta
(S)
Bogdan Moldovan
(B)
Aviram Nissan
(A)
David Orry
(D)
Gloria Ortega Pérez
(GO)
Brice Paquette
(B)
Marius Paskonis
(M)
Pompiliu Piso
(P)
Marc Pocard
(M)
Beat Rau
(B)
Manuela Robella
(M)
Shivendra Singh
(S)
S P Somashekhar
(SP)
Claudio Soravia
(C)
Abelkader Taibi
(A)
Jared Torkington
(J)
Giuseppe Vizzielli
(G)
Wouter Willaert
(W)
Informations de copyright
Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors report no conflicts of interest relevant to this article.