经静电沉淀增强的腹腔内加压气溶胶化疗（ePIPAC）治疗腹膜转移患者。
Pressurized Intraperitoneal Aerosol Chemotherapy Enhanced by Electrostatic Precipitation (ePIPAC) for Patients with Peritoneal Metastases.
机构信息
Digestive Surgery Department, Visceral Surgery Department, Dupuytren Limoges University Hospital, Limoges, France.
CNRS, XLIM, UMR 7252, University Limoges, 87000, Limoges, France.
出版信息
Ann Surg Oncol. 2021 Jul;28(7):3852-3860. doi: 10.1245/s10434-020-09332-6. Epub 2020 Nov 20.
BACKGROUND
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new mode of intraperitoneal chemotherapy administration that can potentially be improved by the addition of electrostatic precipitation (ePIPAC). This study aimed to describe the procedural details of ePIPAC and to analyze its safety for patients with nonresectable peritoneal metastasis as well as their tolerance and response to this treatment.
METHODS
This retrospective cohort study included consecutive patients treated with ePIPAC in three centers from April 2019 to April 2020. The toxicities of each patient were assessed using the Common Terminology Criteria for Adverse Events (CTCAE). Complications were documented according to the Clavien classification. Quality of life (QoL) was assessed using EORTC-QLQ-C30, and the peritoneal regression grading score (PRGS) was used to grade histologic responses. Further surrogates for responses were the Peritoneal Cancer Index (PCI), ascites, and symptoms.
RESULTS
Overall, 69 patients received 147 ePIPACs with oxaliplatin (n = 34) or cisplatin/doxorubicin (n = 35) mainly for colorectal (n = 25), ovarian (n = 14), and gastric (n = 13) primary cancers. Systemic chemotherapy was used in the treatment of 54 patients (76%). The median electrostatic therapy time was 12 min (range 6-30 min). The overall and major CTCAE toxicity rates were respectively 24.6% and 15.9%. The postoperative complications rate according to Clavien classification was 4.7%. The responses of 22 patients who had three or more ePIPAC treatments were evaluated as follows: PCI (16 vs 14; p = 0.4), ascites (320 vs 98 ml; p = 0.1), and PRGS (2.23 vs 1.73; p = 0.15). The complete (PRGS1) and major (PRGS2) histologic responses at the third ePIPAC were respectively 38.5% and 53.8%. Overall QoL was stable during the first ePIPACs.
CONCLUSION
Repetitive ePIPACs were safe and well tolerated for patients with unresectable peritoneal metastasis.
背景
加压腹腔内气溶胶化疗（PIPAC）是一种新的腹腔内化疗给药模式，通过静电沉淀（ePIPAC）的加入，可能会得到改善。本研究旨在描述 ePIPAC 的操作细节，并分析其对不可切除腹膜转移患者的安全性，以及患者对这种治疗的耐受性和反应。
方法
这是一项回顾性队列研究，纳入了 2019 年 4 月至 2020 年 4 月在三个中心接受 ePIPAC 治疗的连续患者。采用不良事件通用术语标准（CTCAE）评估每位患者的毒性。根据 Clavien 分类记录并发症。采用 EORTC-QLQ-C30 评估生活质量（QoL），采用腹膜回归分级评分（PRGS）对组织学反应进行分级。反应的其他替代指标包括腹膜癌指数（PCI）、腹水和症状。
结果
总体而言，69 例患者共接受了 147 次 ePIPAC 治疗，其中 oxaliplatin（n=34）或 cisplatin/doxorubicin（n=35）主要用于结直肠癌（n=25）、卵巢癌（n=14）和胃癌（n=13）。54 例患者（76%）接受了全身化疗。静电治疗时间中位数为 12 分钟（范围 6-30 分钟）。总体和主要 CTCAE 毒性发生率分别为 24.6%和 15.9%。根据 Clavien 分类，术后并发症发生率为 4.7%。对 22 例接受 3 次或更多次 ePIPAC 治疗的患者的反应进行了评估，结果如下：PCI（16 比 14；p=0.4）、腹水（320 比 98ml；p=0.1）和 PRGS（2.23 比 1.73；p=0.15）。第三次 ePIPAC 时完全（PRGS1）和主要（PRGS2）组织学反应分别为 38.5%和 53.8%。在第一次 ePIPAC 期间，总体 QoL 保持稳定。
结论
对于不可切除的腹膜转移患者，重复进行 ePIPAC 是安全且耐受良好的。
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