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Introduction <p>A subset of patients with advanced epithelial ovarian cancer remains unresectable despite standard neoadjuvant chemotherapy (NACT). Pressurized intraperitoneal aerosol chemotherapy (PIPAC) may enhance locoregional response when combined with systemic therapy. We evaluated the safety, feasibility and conversion potential of neoadjuvant bidirectional chemotherapy incorporating PIPAC in patients with initially unresectable disease.</p> Methods <p>This single-center retrospective observational study included 45 patients with FIGO stage IIIC–IVA epithelial ovarian cancer treated between March 2021 and March 2024. All patients received platinum–taxane NACT. Patients deemed unresectable underwent bidirectional chemotherapy consisting of systemic platinum-based chemotherapy combined with PIPAC. The primary outcome was safety &amp; conversion to complete cytoreductive surgery (CRS) with HIPEC. Secondary outcomes included response rates, perioperative morbidity, and short-term surgical outcomes.</p> Results <p>Mean age was 54.5 years and median baseline PCI was 21. Following bidirectional therapy, 28 patients (62.2%) achieved sufficient response for conversion CRS with HIPEC. Favourable histological response (PRGS1) was observed in 44.4%, and 53.4% demonstrated good radiological response. Median standardized KELIM was higher in the conversion group (1.10 vs. 0.98). Minor morbidity during therapy occurred in 23.6% and major morbidity in 11.1%, with no 30-day mortality. Among patients undergoing CRS and HIPEC, CC-0 resection was achieved in 82.1%,major postoperative morbidity was 25.4%, and 90-day mortality was 3.5%.</p> Conclusion <p>Neoadjuvant bidirectional chemotherapy with PIPAC and systemic chemotherapy appears safe, feasible and facilitates surgical conversion in selected patients with advanced ovarian cancer. Prospective studies are warranted to validate long-term survival benefit.</p>

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Neoadjuvant Bi-Directional Chemotherapy with PIPAC and Systemic Chemotherapy in Advanced Epithelial Ovarian Cancer: An Emerging Conversion Strategy for Initially Unresectable Peritoneal Disease

  • 期刊论文

  • 发表日期：

    2026年3月28日

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  • Somashekhar SP,
  • Rohit Kumar C,
  • Esha R. Shanbhag,
  • Ajinkya Pawar,
  • Darshan Patil,
  • Kushal Agrawal,
  • Channappa Patil,
  • Sai Vivek Velkuru,
  • Vaishnavi Srinarahari,
  • Susmita Rakshit,
  • Nikhil S. Reddy ,
  • Pugazhenthi M,
  • Shabnam S. Aboobacker,
  • Vijay Ahuja ,
  • Ashwin KR

摘要

Introduction

A subset of patients with advanced epithelial ovarian cancer remains unresectable despite standard neoadjuvant chemotherapy (NACT). Pressurized intraperitoneal aerosol chemotherapy (PIPAC) may enhance locoregional response when combined with systemic therapy. We evaluated the safety, feasibility and conversion potential of neoadjuvant bidirectional chemotherapy incorporating PIPAC in patients with initially unresectable disease.

Methods

This single-center retrospective observational study included 45 patients with FIGO stage IIIC–IVA epithelial ovarian cancer treated between March 2021 and March 2024. All patients received platinum–taxane NACT. Patients deemed unresectable underwent bidirectional chemotherapy consisting of systemic platinum-based chemotherapy combined with PIPAC. The primary outcome was safety & conversion to complete cytoreductive surgery (CRS) with HIPEC. Secondary outcomes included response rates, perioperative morbidity, and short-term surgical outcomes.

Results

Mean age was 54.5 years and median baseline PCI was 21. Following bidirectional therapy, 28 patients (62.2%) achieved sufficient response for conversion CRS with HIPEC. Favourable histological response (PRGS1) was observed in 44.4%, and 53.4% demonstrated good radiological response. Median standardized KELIM was higher in the conversion group (1.10 vs. 0.98). Minor morbidity during therapy occurred in 23.6% and major morbidity in 11.1%, with no 30-day mortality. Among patients undergoing CRS and HIPEC, CC-0 resection was achieved in 82.1%,major postoperative morbidity was 25.4%, and 90-day mortality was 3.5%.

Conclusion

Neoadjuvant bidirectional chemotherapy with PIPAC and systemic chemotherapy appears safe, feasible and facilitates surgical conversion in selected patients with advanced ovarian cancer. Prospective studies are warranted to validate long-term survival benefit.