Pipac – Technique innovante

Posted on by pacala10

La PIPAC ou CIPPA signifie Chimiothérapie Intra-Péritonéale Pressurisée par Aérosols. Il s’agit d’une technique innovante dans le traitement des carcinoses péritonéales.

La chimiothérapie intrapéritonéale pressurisée (Cippa) a été développée par un chirurgien suisse, Marc-André Reymond, professeur à l’université de la Ruhr, à Bochum, en Allemagne. Centre au sein duquel l’application clinique de la Cippa a été mise en place début 2012 et où 850 patients ont déjà été traités par ce moyen.
Il aura fallu plus de dix ans de travail acharné pour concrétiser cette idée innovante : vaporiser sous pression une chimiothérapie directement dans la cavité abdominale de patients atteints de carcinose péritonéale.

Ce nouveau mode d’administration local est d’autant plus prometteur que la carcinose ­péritonéale représente un défi pour le corps médical. Ce type de cancer est très difficilement détectable à un stade précoce – jusqu’à 40 % des nodules tumoraux passent inaperçus lors d’examens par imagerie – et, jusque-là, il n’existait que peu d’options thérapeutiques capables de pénétrer efficacement dans les tumeurs. Avec pour corollaire une espérance de vie particulièrement réduite pour les patients touchés.

Inspirée par la technologie automobile et ses injecteurs à haute pression (le prototype était d’ailleurs un injecteur de Golf IV Volkswagen !),

«  L’idée est très simple, explique le médecin. Lorsque l’on travaille par laparoscopie, on évolue en milieu fermé puisque seules deux incisions minimes sont effectuées dans le ventre du patient pour passer une caméra et une canule d’insufflation. Il est donc possible d’induire des modifications thérapeutiques de ce milieu, contrairement à une chirurgie conventionnelle ouverte. »

Réduire dix fois la dose
Par l’action combinée de la ­vaporisation et de la pression supplémentaire injectée dans l’abdomen du patient, la Cippa permet une distribution homogène de la chimiothérapie…

Elle s’adresse aux personnes non éligibles au programme « CHIP en association avec la chirurgie ».

Cette procédure, apparentée à la chimiothérapie hyperthermique intrapéritonéale (CHIP) utilisée depuis plusieurs années, offre de nouvelles perspectives pour la prise en charge de patients atteints de pathologies cancéreuses limitées à la cavité abdominale.

Ses conditions de mise en œuvre peuvent cependant exposer les intervenants pendant et après la CIPPA à de nouveaux risques. L’introduction de cette technique impose donc au service de soins de renouveler leur évaluation des risques et de définir notamment des mesures adaptées de prévention des risques d’exposition aux médicaments cytotoxiques.

La chimiothérapie classique coûte entre 3 000 et 5 000 euros, contre une vingtaine d’euros par dose pour la chimiothérapie par vaporisation à haute pression.

Source LE MONDE SCIENCE ET TECHNO

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