Best PIPAC Treatment in Mumbai

Best PIPAC Treatment in Mumbai

PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a minimally invasive treatment used for patients with peritoneal metastases (cancer spread within the abdominal cavity). It delivers chemotherapy directly into the abdomen as a pressurized aerosol during a laparoscopic procedure. The technique aims to improve drug distribution and tissue penetration while reducing systemic toxicity compared with conventional intravenous chemotherapy.

During the procedure, surgeons insert laparoscopic ports into the abdomen and create a pneumoperitoneum (inflation of the abdominal cavity with gas). Chemotherapy drugs are then aerosolized and administered under pressure, allowing more uniform exposure of tumor surfaces. Commonly used agents include cisplatin, doxorubicin, or oxaliplatin, depending on the cancer type.

PIPAC is most often considered for patients with advanced or unresectable peritoneal carcinomatosis from cancers such as gastric, colorectal, ovarian, appendiceal, and pancreatic tumors. It is usually repeated every 6–8 weeks and may be combined with systemic chemotherapy as part of a multimodal treatment strategy.

Potential advantages of PIPAC include improved local drug delivery, lower chemotherapy doses, reduced systemic side effects, symptom control, and preservation of quality of life. The procedure also allows direct visualization of the peritoneal cavity and repeated biopsies to assess treatment response.

Current evidence suggests that PIPAC is feasible and safe. Useful in controlling a site as second-line management if chemotherapy fails

Trials of PIPAC in colorectal cancer, the key studies are:

1. CRC-PIPAC Trial

• Multicenter, single-arm Phase II trial.
• Evaluated oxaliplatin-based PIPAC (PIPAC-OX) in patients with unresectable colorectal peritoneal metastases.
• Patients received PIPAC every 6 weeks.
• Results showed acceptable safety and evidence of antitumor activity, supporting further investigation. 

2. CRC-PIPAC-II

• Combined standard systemic chemotherapy (CAPOX, FOLFOX, FOLFIRI, or FOLFOXIRI ± bevacizumab) with electrostatic PIPAC (ePIPAC).
• Demonstrated feasibility and manageable toxicity.
• Pathological response was observed in a large proportion of patients, with median progression-free survival of about 10 months and overall survival around 17.5 months. 

3. PIPAC-OPC1 and PIPAC-OPC2

• Included patients with colorectal peritoneal metastases treated with oxaliplatin-based PIPAC.
• Reported histological tumor regression in many patients and helped establish the safety and feasibility of the technique. 

Key Takeaway

PIPAC for colorectal cancer is primarily studied in patients with unresectable peritoneal metastases. Current trials suggest:

• Good feasibility and safety.
• Promising pathological response rates.
• Potential improvement in symptom control and disease stabilization.