Intraperitonealna aerosolna kemoterapija pod povišanim pritiskom PIPAC (Pressurized intraperitoneal aerosol chemotherapy)

Abstract

Bolniki s peritonealnimi metastazami imajo kljub multimodalnemu zdravljenju s kirurgijo in kemoterapijo slabo prognozo. Samo citoreduktivna kirurgija  je lahko kurativna pri zdravljenju peritonealne karcinoze, toda le manjši delež bolnikov je primeren za kirurško zdravljenje. Pri neresektabilni peritonealni karcinozi je kemoterapija edina možna terapija z omejenim učinkom na peritonealne metastaze zaradi slabe vaskularizacije in nizke penetracije zdravila. Intraperitonealna aerosolna kemoterapija pod pritiskom (PIPAC) je nova minimalno invazivna metoda, ki s pomočjo  laparoskopije omogoča aplikacijo citostatika v abdomen v obliki aerosolov pod povišanim pritiskom, kar omogoča boljšo razporeditev zdravila v abdominalni votlini in globjo penetracijo zdravila. PIPAC je tehnično varen postopek, ki omogoča zdravljenje izolirane peritonealne karcinoze različnih vrst tumorjev. Objavljeni rezultati zdravljenja peritonealnih metastaz različnih vrst tumorjev s PIPAC so obetavni. Trenutno potekajo številne prospektivne študije, ki analizirajo terapevtsko učinkovitost PIPAC-a pri različnih indikacijah z različnimi zdravili.

Abstract (Eng)

Patients with peritoneal carcinomatosis have a poor prognosis despite multimodal treatment with surgery and chemotherapy. Cytoreductive surgery is the only curative option for the treatment of carcinomatosis but only minority of patients are eligible for surgical treatment. For non-resectable peritoneal carcinomatosis, chemotherapy is the only possible option with limited effect on the peritoneal metastases due to poor vascularization and low penetration of the drug. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a new minimally invasive method using laparoscopy to deliver chemotherapy in the form of pressurized aerosol into the abdomen allowing better distribution of the drug in the abdominal cavity and deeper penetration of the drug. PIPAC is technically feasible and safe procedure useful as a treatment option for isolated peritoneal carcinomatosis of various origins. Promising results have been published in the treatment of the peritoneal metastases of all origin with PIPAC. Many prospective clinical trials are ongoing evaluating oncological efficacy of PIPAC in multiple indications with various drugs.