Multivisceral resection for ovarian cancer with peritoneal carcinomatosis following induction bidirectional chemotherapy using pressurized intraperitoneal aerosol chemotherapy

Peritoneal carcinomatosis in advanced ovarian cancer is an unfavorable prognostic factor and limits the efficacy of systemic chemotherapy. This provides a rationale for the use of locoregional treatment modalities, including pressurized intraperitoneal aerosol chemotherapy (PIPAC). Of particular interest is the safety of a bidirectional strategy (systemic chemotherapy + PIPAC) in patients requiring multivisceral resection.

We present a clinical case of a patient with advanced ovarian cancer and peritoneal carcinomatosis. Induction bidirectional chemotherapy was administered, consisting of paclitaxel/carboplatin (6 cycles) combined with PIPAC using cisplatin 30 mg/m² (50 mg), 30-minute exposure, 3 sessions, followed by multivisceral cytoreductive surgery. Efficacy was assessed based on tumor marker dynamics, peritoneal cancer index (PCI), and morphological response (TRG), while safety was evaluated according to perioperative complications and the feasibility of continuing PIPAC after surgery.

At initial laparoscopy in April 2025, peritoneal carcinomatosis was detected (PCI 26); the first PIPAC session was performed, followed by systemic chemotherapy. After the second cycle, a partial response was documented. In June 2025, multivisceral cytoreductive surgery was performed, including anterior resection of the rectum with sigmoid stoma formation. Systemic therapy was resumed early and completed up to 6 cycles. By 20.08.2025, tumor markers had decreased: CA-125 to 47 U/mL, CA 19–9 to 13.7 U/mL, and HE-4 to 120 U/mL. Before PIPAC-2 (September 2025), no macroscopic carcinomato sis was detected (PCI 0); no tumor cells were found in peritoneal biopsy specimens, corresponding to TRG 1. At PIPAC-3 (November 2025), PCI remained 0, and repeat biopsies also corresponded to TRG 1.

Induction bidirectional chemotherapy including PIPAC in a patient with advanced ovarian cancer and peritoneal carcinomatosis demonstrated clinical feasibility, safety and marked antitumor efficacy even after multivisceral cytoreduction.

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