Optimal Nozzle Position and Patient’s Posture to Enhance Drug Delivery into the Peritoneum during Rotational Intraperitoneal Pressurized Aerosol Chemotherapy in a Swine Model

Even though rotational intraperitoneal pressurized aerosol chemotherapy (RIPAC) has been developed to improve the distribution and penetration depth of anti-cancer agents by pressurized intraperitoneal aerosol chemotherapy (PIPAC), the optimal nozzle position and patient’s posture have not been investigated. Thus, we used nine pigs weighing 50–60 kg, and sprayed 150 mL of 1% methylene blue as an aerosol through the nozzle, DreamPen® (Dreampac Corp., Wonju, Republic of Korea), with a flow rate of 0.6 ml/min under a pressure of 140 to 150 psi for RIPAC in six and three pigs with supine and Trendelenburg positions, respectively. When we evaluated its distribution and penetration depth, even distribution among 13 regions of the abdomen was observed in three pigs with Trendelenburg position regardless of the depth of the nozzle. Regarding penetration depth, the numbers of regions with maximal penetration depth were high in the 2 cm depth of the nozzle with supine position (n = 5) and the 4 cm depth with Trendelenburg position (n = 3). Conclusively, even distribution and maximal penetration of anti-cancer agents can be expected during RIPAC in the medium depth (4 cm) between the nozzle inlet and the visceral peritoneum located on the opposite side of it and the Trendelenburg position.

[1]  J. Park,et al.  Rotational intraperitoneal pressurized aerosol chemotherapy with paclitaxel and cisplatin: pharmacokinetics, tissue concentrations, and toxicities in a pig model , 2022, Journal of gynecologic oncology.

[2]  J. C. Lee,et al.  Ideal Nozzle Position During Pressurized Intraperitoneal Aerosol Chemotherapy in an Ex Vivo Model , 2021, AntiCancer Research.

[3]  M. Pocard,et al.  Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomised, open-label, phase 3 trial. , 2021, The Lancet. Oncology.

[4]  J. C. Lee,et al.  Development of rotational intraperitoneal pressurized aerosol chemotherapy to enhance drug delivery into the peritoneum , 2021, Drug delivery.

[5]  S. Park,et al.  Pressurized intraperitoneal aerosol chemotherapy for recurrent ovarian, fallopian or primary peritoneal cancer with peritoneal carcinomatosis: a narrative review. , 2020, Gland surgery.

[6]  S. Park,et al.  Rotational intraperitoneal pressurized aerosol chemotherapy in a porcine model. , 2020, Gland surgery.

[7]  J. C. Lee,et al.  Evaluation of a Novel Prototype for Pressurized Intraperitoneal Aerosol Chemotherapy , 2020, Cancers.

[8]  G. Song,et al.  Selection of patients with ovarian cancer who may show survival benefit from hyperthermic intraperitoneal chemotherapy , 2019, Medicine.

[9]  M. Hübner,et al.  Pressurised intraperitoneal aerosol chemotherapy: rationale, evidence, and potential indications. , 2019, The Lancet. Oncology.

[10]  W. Solass,et al.  Feasibility, Safety, and Efficacy of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) for Peritoneal Metastasis: A Registry Study , 2018, Gastroenterology research and practice.

[11]  Ryan J. Hendrix,et al.  Palliative Management of Advanced Peritoneal Carcinomatosis. , 2018, Surgical oncology clinics of North America.

[12]  N. Aaronson,et al.  Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer , 2018, The New England journal of medicine.

[13]  E. Förster,et al.  Distribution pattern and penetration depth of doxorubicin after pressurized intraperitoneal aerosol chemotherapy (PIPAC) in a postmortem swine model , 2016, Journal of Cancer Research and Clinical Oncology.

[14]  E. Förster,et al.  Evaluating the Effect of Micropump© Position, Internal Pressure and Doxorubicin Dosage on Efficacy of Pressurized Intra-peritoneal Aerosol Chemotherapy (PIPAC) in an Ex Vivo Model. , 2016, Anticancer research.

[15]  E. Förster,et al.  Exploring the Spatial Drug Distribution Pattern of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) , 2016, Annals of Surgical Oncology.

[16]  W. Solass,et al.  Quality of life of patients with end-stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC). , 2015, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[17]  L. Lambert Looking up: Recent advances in understanding and treating peritoneal carcinomatosis , 2015, CA: a cancer journal for clinicians.

[18]  P. Dankers,et al.  Targeting the peritoneum with novel drug delivery systems in peritoneal carcinomatosis: a review of the literature. , 2015, Anticancer research.

[19]  N. Gourtsoyiannis,et al.  Peritoneal carcinomatosis , 2014, European Radiology.

[20]  S. Loibl,et al.  The impact of second to sixth line therapy on survival of relapsed ovarian cancer after primary taxane/platinum-based therapy. , 2012, Annals of oncology : official journal of the European Society for Medical Oncology.