Pressurized intraperitoneal aerosol chemotherapy in peritoneal carcinomatosis due to recurrent ovarian cancer

Ovarian cancer is typically diagnosed at stages 3 or 4, and up to 80% of patients develop peritoneal metastasis. Although initial chemotherapy with carboplatin and paclitaxel is effective, recurrence rates for recurrent ovarian cancer (ROC) reach approximately 75%. Recently, a minimally invasive approach known as pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been developed, in which chemotherapy is administered as a pressurized aerosol under laparoscopy. This study aimed to present the early outcomes of PIPAC for peritoneal carcinomatosis due to ROC. Data from ROC patients with ROC treated between January 2020 and January 2025 were retrospectively reviewed. PIPAC was performed alongside systemic chemotherapy for 6-week cycles, with at least 3 sessions. The chemotherapy regimen consisted of doxorubicin 2.1 mg/m² and cisplatin 10.5 mg/m² administered via a nebulizer and injector, respectively, at 37°C for 30 minutes. Statistical analysis was conducted using SPSS version 25.0. Normality was assessed with histogram plots and the Shapiro-Wilk test, as it is more appropriate for small sample sizes. Categorical variables were compared with the chi-squared test. The Mann-Whitney U and Kruskal-Wallis tests were used for non-parametric comparisons, with post hoc analysis as needed. Spearman correlation assessed relationships between variables. Cox regression analyzed factors affecting survival, and Kaplan-Meier analysis was used for overall survival. A P-value < .05 was considered statistically significant. A total of 26 PIPAC cycles were performed in 11 ROC patients with ROC. The mean pretreatment Peritoneal Carcinomatosis Index score was 23.18, which decreased to 15.36 after systemic chemotherapy and PIPAC. According to the Peritoneal Regression Grading Score, 3 (27.3%) patients had a complete response, 4 (36.4%) had a major response, 3 (27.3%) had a minor response, and 1 (9%) had no response. Two patients (18.2%) underwent secondary cytoreductive surgery + hyperthermic intraperitoneal chemotherapy. The median overall survival was 15.13 months. Early results indicated that PIPAC may improve survival in patients with platinum-resistant ROC without increasing morbidity. Approximately 20% of patients are candidates for secondary cytoreductive surgery. The low toxicity and repeatability of PIPAC when combined with systemic chemotherapy may improve treatment efficacy. Larger multicenter randomized trials are needed.