Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for the treatment of malignant mesothelioma.
Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for the treatment of malignant mesothelioma.
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DOI：
10.1186/s12885-018-4363-0
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发表时间：
2018-04-18
期刊：
影响因子：
3.8
通讯作者：
Tempfer CB
中科院分区：
文献类型：
--
作者：
Giger-Pabst U;Demtröder C;Falkenstein TA;Ouaissi M;Götze TO;Rezniczek GA;Tempfer CB
手术和顺铂和培美曲塞标准化疗后复发的恶性上皮样间皮瘤（MM）患者的治疗选择有限。我们对接受多柔比星1.5 mg/m2和顺铂7.5 mg/m2加压腹膜内/胸内气雾剂化疗（PIPAC/PITAC）的复发性MM患者进行了一项回顾性队列研究。在接受PIPAC/PITAC患者的前瞻性登记研究中回顾性收集数据。研究结局为显微镜肿瘤消退等级（TRG）、生存期和不良事件（v4.0 CTCAE）。共分析了29例MM患者（m/f = 17/12），平均年龄为62.4岁（范围：42 - 84）。共进行了74例PIPAC和5例PITAC手术。PIPAC应用的平均次数为每例患者2.5次（范围：0 - 10次）。20名患者（69%）接受了> 2次PIPAC手术，有资格进行TRG分析。在75%（15/20）的患者中观察到TRG 1至4。分别在20%和10%的患者中观察到严重消退（TRG 3）或完全消退（TRG 4）。PIPAC在51.7%（15/29）的患者中诱导了显著的肿瘤消退，在重复PIPAC后具有累积效应（PIPAC #1与PIPAC #2：p = 0.001; PIPAC #1与PIPAC #3：p = 0.001; PIPAC #1与PIPAC #4：p = 0.001）。在2例（6.9%）接受细胞减灭术（CC 2）和术中PIPAC的患者中观察到术后CTCAE 4级并发症。1例患者（3.4%）死于术后肾功能不全。在最后一次PIPAC/PITAC应用后随访14.4（95% CI：8.1至20.7）个月后，中位总生存期为26.6（95% CI：9.5至43.7）个月（从首次应用开始）。在先前的腹部手术和全身化疗后，反复应用PIPAC对于终末期MM患者是可行和安全的。此外，PIPAC在大多数患者中诱导恶性间皮瘤的显著组织学消退。PITAC是可行的，但其控制恶性胸腔积液的安全性和有效性尚不清楚。本文的在线版本（10.1186/s12885-018-4363-0）包含补充材料，可供授权用户使用。
Patients with recurrent malignant epithelioid mesothelioma (MM) after surgery and standard chemotherapy with cisplatin and pemetrexed have limited treatment options. We performed a retrospective cohort study of patients with recurrent MM undergoing Pressurized IntraPeritoneal/Thoracal Aerosol Chemotherapy (PIPAC/PITAC) with doxorubicin 1.5 mg/m2 and cisplatin 7.5 mg/m2. Data were retrospectively collected in a prospective registry of patients undergoing PIPAC/PITAC. Study outcomes were microscopic tumor regression grade (TRG), survival and adverse events (v4.0 CTCAE). A total of 29 patients (m/f = 17/12) with MM with a mean age of 62.4 (range: 42 to 84) years were analyzed. A total of 74 PIPAC and 5 PITAC procedures were performed. The mean number of PIPAC applications was 2.5 (range: 0 to 10) per patient. Twenty patients (69%) had > 2 PIPAC procedure and were eligible for TRG analysis. TRG 1 to 4 was observed in 75% (15/20) of patients. Major regression (TRG 3) or complete regression (TRG 4) was observed in 20% and 10%, respectively. PIPAC induced significant tumor regression in 51.7% (15/29) of patients with a cumulative effect after repetitive PIPACs (PIPAC #1 vs. PIPAC #2: p = 0.001; PIPAC #1 vs. PIPAC #3: p = 0.001; PIPAC #1 vs. PIPAC #4: p = 0.001). Postoperative CTCAE grade 4 complications were observed in two patients (6.9%) who had cytoreductive surgery (CC2) and intraoperative PIPAC. One patient (3.4%) died due to postoperative kidney insufficiency. After a follow up of 14.4 (95% CI: 8.1 to 20.7) months after the last PIPAC/PITAC application, median overall survival was 26.6 (95% CI: 9.5 to 43.7) months (from the first application). After prior abdominal surgery and systemic chemotherapy, repetitive PIPAC applications are feasible and safe for patients with end-stage MM. Furthermore, PIPAC induces significant histological regression of malignant mesothelioma in the majority of patients. PITAC is feasible, but its safety and efficacy to control malignant pleural effusion remain unclear. The online version of this article (10.1186/s12885-018-4363-0) contains supplementary material, which is available to authorized users.
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