The effect of Pressurised Intraperitoneal Aerosol Chemotherapy on the quality of life of patients with primary diagnosed ovarian cancer with peritoneal carcinomatosis during combined treatment

Purpose of the study. To evaluate the effect of Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) on the quality of life of patients during standard combined treatment of newly diagnosed ovarian cancer.

Patients and methods. A combination of surgical cytoreduction with a simultaneous session of intra‑abdominal aerosol chemotherapy under pressure and subsequent systemic chemotherapy within the framework of a single hospitalization was used. The study included 164 patients (79 in the main group, 85 in the control group). All patients were operated on at the first stage, all underwent systemic cytostatic therapy according to the TS scheme (6 courses with an interval of 21 days). In the main group, 3 PIPEC sessions were added to standard treatment: the first one simultaneously with cytoreductive surgery, followed by 2 more PIPAC sessions with an interval of 42 days. To assess the quality of life, the EORTC‑QLQ – C30 questionnaire was used, which the patients filled out 4 times: before the cytoreductive stage, and then after completing the first, third and fifth courses of systemic polychemotherapy (PCT).

Results. Before the start of treatment in the control group, the average general condition was 1.6 ± 1.1 points, then 1.32 ± 1.0 points, then 0.96 ± 0.97 and 0.78 ± 0.87 points at the end of the 6th course of systemic PCT. A similar situation has developed in the main group. The average baseline value before treatment was 1.7 ± 1.1 points, with the second questionnaire – 1.3 ± 1.1 points, with the third questionnaire – 0.66 ± 0.83, and 0.43 ± 0.75 points with the fourth questionnaire. In the control group, the average assessment of the quality of life before treatment was 55.0 ± 11.0 points, and then sequentially with the following three surveys 50,8 ± 7,5, 47 ± 8, 45,6 ± 8,1 points, which indicates an improvement in the quality of life against the background of ongoing treatment. In the main group, the basic level of assessment of the quality of life was 53.8 ± 11.3 points. Subsequently, an improvement in the indicators was also revealed: 49.6 ± 7.5 points, 44.2 ± 5.3 points and 42.1 ± 5.4 points, respectively. The homogeneity of the distribution in the groups was established by means of an accurate two–way Wilcoxon–Mann‑Whitney rank sum criterion, the actual significance level was p = 0.498. A two‑factor model of nonparametric analysis of variance (ANOVA) was used to analyze the data obtained. To identify a significant difference between the indicators at different stages of the study, the Page rank criterion for an ordered alternative and an algorithm based on the Friedman rank sum test were used. As a result, it was shown that the revealed positive dynamics of indicators within the groups over the entire study period is statistically significant (p < 0.0001).

Conclusion. The results of the study showed that PIPAC not only does not reduce the quality of life and does not worsen the well‑being of patients, but also improves these indicators by the time of completion of combined treatment (after the 6th course of systemic PCT): in the main group, the overall ECOG condition at this stage was estimated at 0.43 ± 0.75 points, in the control group – 0.78 ± 0.87 points. The survey of patients using EORTC‑QLQ – C30 at this stage showed that in the main group the indicator was 42.1 ± 5.4 points versus 45.6 ± 8.1 points in the control group of the study.

1. Suarez‑Almazor M, Pinnix C, Bhoo‑Pathy N, Lu Q, Sedhom R, Parikh RB. Quality of life in cancer care. Med (N Y). 2021 Aug 13;2(8):885–888. https://doi.org/10.1016/j.medj.2021.07.005

2. McNair KM, Zeitlin D, Slivka AM, Lequerica AH, Stubblefield MD. Translation of Karnofsky Performance Status (KPS) for use in in‑patient cancer rehabilitation. PM R. 2023 Jan;15(1):65–68. https://doi.org/10.1002/pmrj.12741

3. Sok M, Zavrl M, Greif B, Srpčič M. Objective assessment of WHO/ECOG performance status. Support Care Cancer. 2019 Oct;27(10):3793–3798. https://doi.org/10.1007/s00520‑018‑4597‑z

4. Lewandowska A, Rudzki G, Lewandowski T, Próchnicki M, Rudzki S, Laskowska B, Brudniak J. Quality of Life of Cancer Patients Treated with Chemotherapy. Int J Environ Res Public Health. 2020 Sep 23;17(19):6938. https://doi.org/10.3390/ijerph17196938

5. Quinten C,Coens C,Ghislain I,Zikos E,Sprangers MA,Ringash J,et al.;PROBE;EORTC Clinical Groups.The effects of age on health‑related quality of life in cancer populations: A pooled analysis of randomized controlled trials using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ‑C30 involving 6024 cancer patients. Eur J Cancer. 2015 Dec;51(18):2808–2819. https://doi.org/10.1016/j.ejca.2015.08.027

6. Novik AA, Ionova TI. Guidelines for the study of quality of life in medicine. 4th ed. Ed. RAS acad. Yu. I. Shevchenko. Мoscow: Publishing House of the National Medical and Surgical Center named after N. I. Pirogov,, 2021, 664 p. (In Russ.).

7. Reymond MA, Hu B, Garcia A, Reck T, Köckerling F, Hess J, Morel P. Feasibility of therapeutic pneumoperitoneum in a large animal model using a microvaporisator. Surg Endosc. 2000 Jan;14(1):51–55. https://doi.org/10.1007/s004649900010

8. Odendahl K, Solass W, Demtröder C, Giger‑Pabst U, Zieren J, Tempfer C, Reymond MA. Quality of life of patients with end‑stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC). Eur J Surg Oncol. 2015 Oct;41(10):1379–1385. https://doi.org/10.1016/j.ejso.2015.06.001

9. Dzasokhov AS, Kostin AA, Astashov VL, Khomyakov VM, Uskov AD, Andreeva MA, Utkina AB. Description of the first clinical case of a combination of surgical cytoreduction and pressurized intraperitoneal aerosol chemotherapy in the treatment of ovarian cancer. P. A. Herzen Journal of Oncology. 2021;10(2):41–47. https://doi.org/10.17116/onkolog2021100215