Occupational exposure to cisplatin/oxaliplatin during Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)?
INTRODUCTION
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a new promising treatment for patients with peritoneal carcinomatosis. It is supposed to provide a higher local drug concentration and deeper penetrate into the tumor tissue compared to systemic chemotherapy or hyperthermic intraperitoneal chemotherapy perfusion (HIPEC). Due to the application of cytotoxic drug aerosols within the operating room (OR), concern has been raised regarding the occupational exposure risk of the involved OR staff.


MATERIALS AND METHODS
In this study, an OR workplace monitoring was performed during 14 PIPAC procedures in two hospitals by collecting air samples (n = 14) during PIPAC and wipe samples (n = 223) before and after PIPAC: 56 samples from the OR floor, 84 from the injector, 28 from trocars and 55 from gloves. All samples were analyzed for platinum (Pt).


RESULTS
While air Pt concentrations were below 3.1 pg/m³, surface contaminations widely varied between 0.01 pg/cm2 and 1733 pg/cm2 (median 1.04 pg/cm2), with substantial Pt concentrations on injector parts (i.e. syringe holder) and trocars. Floors and particularly injectors were often higher contaminated before compared to after PIPAC, probably due to inefficient cleaning or cross-contamination. Glove samples taken after different tasks ranged between 0.04 and 423 pg/cm2 (median 0.58 pg/cm2).


CONCLUSION
Contamination on various OR surfaces widely ranged and can lead to a distribution of cytotoxic drug residues. However, the air contamination was very low. The results indicate that PIPAC performance seems to be possible with low occupational exposure risk, but adequate safety and cleaning standards for PIPAC must be developed and monitored.
['Ametsbichler|Paul|P|', 'Böhlandt|Antje|A|', 'Nowak|Dennis|D|', 'Schierl|Rudolf|R|']
D000336:Aerosols D000971:Antineoplastic Combined Chemotherapy Protocols D002945:Cisplatin D004784:Environmental Monitoring D004866:Equipment Contamination D004867:Equipment Design D005858:Germany D006801:Humans D016273:Occupational Exposure D009873:Operating Rooms D009944:Organoplatinum Compounds D000077150:Oxaliplatin D010534:Peritoneal Neoplasms
Occupational exposure PIPAC Peritoneal carcinomatosis Platinum Contamination Environmental monitoring