PIPAC ushers hope for patients with advanced abdominal cancer

The therapy to treat peritoneal cancer was recently conducted on 62-year-old woman at SL Raheja, Mahim

A new procedure known as Pressurised Intra-Peritoneal Aerosolised Chemotherapy (PIPAC), is a combination of surgery and chemotherapy is changing the way peritoneal cancers are treated. Recently, a 62-year-old lady suffering from ovarian cancer, after having gone through 24 cycles of strenuous Chemotherapy, was recommended this technique by Dr Ninad Katdare, specialist in Peritoneal, Gastrointestinal and Gynaecological Cancers at SL Raheja Hospital, Mahim.

In this approach, upon admission, routine investigations and fitness for anaesthesia is evaluated. After a detailed evaluation of the extent of disease, the spread is mapped and biopsies are taken. The patient is taken to the OT where the laparoscopic procedure is done. Using a special unique use device, the standard liquid chemotherapy is converted into a gas/ aerosol form and is sprayed directly on the intra-abdominal tumour. After spraying, there is a necessary duration of waiting for the chemotherapy to act. After the procedure is done, the residual fumes are absorbed through a special filter and the incision is closed. If the patient is comfortable, the patient can be discharged the same day or the next morning. A minimum of three cycles are needed to assess the response and further treatment is planned accordingly.

The highlight of this novel technique is that the chemotherapy dose used in aerosol format is just 10 per cent of the standard dose administered orally or intravenous. Reportedly, there are no or minimal side effects like hair loss, Kidney problems, Liver problems, vomiting etc. Any patient with peritoneal cancers who is fit to withstand a two hour surgery under anaesthesia, is compatible for this therapy. Administrations can be repeated; internationally accepted regime is to repeat PIPAC procedure every 6 – 8 weeks, this eliminates cumulative toxicity (adverse effects as the result of long term exposure to a toxicant or other stressor) too. Therefore, this procedure is very well tolerated by all patients. The biggest advantage is that, this therapy works where even standard chemotherapy has failed for Peritoneal Cancers.

Pioneer of PIPAC in India, Dr Katdare, says, “Although the success rates for this procedure vary from patient to patient, the minimum effect it has, is reduction in the ascites and rates of intestinal obstruction, which are the worst sequelae of untreatable peritoneal cancers. (Ascites is collection of fluid in the abdomen upto 10 litres or more which causes great discomfort to the patient. Patient cannot lie down or sit comfortably or even eat properly. Intestinal obstruction is block in the instestines caused by the cancer) The best results it can have is complete resolution of the peritoneal disease with possibility of either observation or use of cytoreductive surgery and HIPEC to potentially cure the patient in a stage 4 cancer. i.e if the disease responds completely, the patient can be observed till further recurrence and if required more PIPAC cycles can be administered without increasing the toxicity. The difference in response varies with the type and subtype of tumors”.