An innovative, aerosol-based therapy developed in Europe to treat peritoneal carcinomatosis (cancer of the abdominal lining) is being employed in America at Hackensack Meridian JFK University Medical Center.
Hackensack Meridian Central Region Surgical Oncology Chief Benjamin Golas and Eric Pletcher, surgical oncologist at JFK, who along with a specially trained multidisciplinary team, recently performed this procedure. The aerosol-based approach to delivering chemotherapy through the PIPAC method is more targeted than systemic chemotherapy.
Peritoneal carcinomatosis is a rare form of cancer in the abdominal cavity that can occur from the spread (metastasis) of cancer from other organs including the colon, rectum, ovaries, stomach or pancreas – or originate directly from the abdominal cavity lining (i.e. mesothelioma).
Systemic chemotherapy delivered throughout the entire body is one approach, but classically, it’s very difficult to target the peritoneal lining through this method.
The PIPAC approach is a less invasive – and more direct – way of delivering chemotherapy to the abdominal cavity. It’s a laparoscopic approach in which a few small incisions in the abdomen are made. A small camera is inserted, followed by a pen-like device that injects an aerosolized version of chemotherapy into the peritoneal lining. The advantage of offering treatment administered through a pressurized delivery mechanism results in a more targeted and effective distribution of chemotherapy without significant side effects.
Typical treatment for peritoneal cancer can range from systemic chemotherapy to cytoreductive surgery and/or a procedure called HIPEC. Cytoreductive surgery (CRS) is a debulking surgery in which tumors and affected tissue are removed. This sometimes includes the removal of organs and can result in procedures that can last up to 12 hours. CRS can also be coupled with HIPEC (hyperthermic intraperitoneal chemotherapy), a procedure that bathes the abdominal cavity in heated chemotherapy. Recovery from CRS and HIPEC can mean a hospital stay of up to two weeks. With PIPAC, the entire procedure lasts about 90 minutes and patients typically go home the same day.
PIPAC can be given as adjuvant therapy concurrently with chemotherapy to further ensure that as many cancer cells as possible are destroyed. It can also be used as a type of ‘bridge therapy’ given prior to CRS/HIPEC for maximum impact. For this route, PIPAC is used to stunt the growth of any tumors so that there’s a better chance of removing them during the debulking surgery.
Any patient with peritoneal carcinomatosis is a candidate for this procedure.
