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Page 4 of 6                              Macedo et al. J Cancer Metastasis Treat 2018;4:8  I  http://dx.doi.org/10.20517/2394-4722.2017.72


               Table 1. Main conclusions of the studies
                Authors         Year          Patients             Aerosol               Conclusion
                Nadiradze et al. [6]  2016 24 patients with peritoneal metastases   Doxorubicin 1.5 mg/m   2  Follow-up: 248 days;
                                    from gastric cancer resistant to systemic   followed by cisplatin   median survival time: 15.4 months;
                                    chemotherapy and with no option for   7.5 mg/m 2  survival after follow-up time: 13 patients;
                                    cytoreductive surgery and HIPEC            objective tumor response in 12 patients;
                                                                               complete histological regression in 6
                                                                               patients
                                                                            2
                Hübner et al. [7]  2017 58 patients with peritoneal disease from   Doxorubicin 1.5 mg/m  in  Intraoperative event rate: 11%;
                                    digestive cancer that was persistent or   combination with cisplatin  deaths after the procedure: 1 patient
                                    progressive after prior standard surgical   7.5 mg/m 2
                                    and/or medical treatment
                Tempfer [8]     2015 1 patient with peritoneal disease from   Doxorubicin 1.5 mg/m 2   Survival of 109 days;
                Solass et al. [9]  2014  gastric cancer after gastrectomy and 2   with cisplatin 7.5 mg/m 2  the patient developed liver and bone
                                    chemotherapy lines                         metastases but with no evidence of
                                                                               peritoneal metastases
                Teixeira Farinha et al. [10]  2017 42 patients: 21 patients with   Not mentioned  PIPAC had no negative impact on patients’
                                    chemoresistent isolated peritoneal         overall quality of life or in main symptoms;
                                    carcinomatosis from gynecological          there was no worse quality of life in PIPAC
                                    origin, 14 patients from colorectal origin   patients with high intraperitoneal tumor
                                    and 3 from gastric origin                  load
                Girshally et al. [11]  2016 9 patients with advanced peritoneal   Doxorubicin 1.5 mg/m   2  7 patients obtained objective radiological
                                    disease no candidates for primary   followed by cisplatin   tumor regression;
                                    cytoreductive surgery and HIPEC  7.5 mg/m 2  8 patients obtained objective major
                                                                               histological regression
                Alyami et al. [12]  2017 73 patients with non-resectable   Cisplatin 7.5 mg/m   2  63.5% of patients presented complete
                                    peritoneal carcinomatosis (26 from   followed by doxorubicin   regression of symptoms;
                                    gastric cancer)           1.5 mg/m 2       peritoneal cancer index improved in 64.5%
                                                                               of patients
               PIPAC: pressurized intraperitoneal aerosol chemotherapy; HIPEC: hypertermic intraperitoneal chemotherapy

               No significant renal toxicity was documented in these studies, however a low-grade liver toxicity was
                                                         [6]
               reported in a quarter of patients in Nadiradze et al.  study.
                          [7]
               Hübner et al.  concluded that no learning curve was observed because the operation time did not decrease
               over time. Some minor complications were observed during this study such as constipation, ileus, transitory
               neutropenia, urinary retention and wound complications. Looking to these effects, the procedure seems to
               be safe. Only one patient died due to cardiac arrhythmia.


                           [8]
               Tempfer et al.  reported that delivering chemotherapy as an aerosol did not represent a risk to health
               care workers so, it could be used safely in the clinical setting. Moreover, the quality of life improved over
               5-6 months.

                         [9]
               Solass et al.  achieved 2 complete remissions and all 3 cases had tumor response. The mean survival of the 3
               patients was 288 days, and the gastric cancer patients died 109 days after the procedure.

                                 [10]
               Teixeira Farinha et al.  concluded that PIPAC had no undesirable impact on quality of life of patients with
               peritoneal carcinomatosis. A shorter hospital stay was associated with patients with better scores at baseline
               in quality of life. Nondigestive and digestive symptoms remained uncharged after repeated treatments.

                           [11]
               Girshally et al.  concluded that patients with extensive peritoneal disease that were treated with PIPAC as
               neoadjuvant therapy had worse prognosis than those treated primarily with citoreductive surgery and HIPEC
               in limited disease. However, when the cytoreductive surgery and HIPEC were not possible due to extensive
               disease, PIPAC was successful in diminishing the tumor burden and allowed forward procedures.


                           [12]
               Alyami et al.  found that symptoms related to peritoneal carcinomatosis like ascites, pain or transit
               disorders were decreased during PIPAC. Some major complications occurred in 9.7% of the patients and 5
               died within 30 days of the PIPAC procedure.
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