Fig. 2

Contrast-enhanced CT scans of a 57-year-old male patient with peritoneal metastasis of an appendiceal cancer. a Image after 12 cycles of combination palliative chemotherapy with FOLFOX4 and 6 cycles of FOLFIRI showing active disease with massive ascites (asterisk). b Evolution after 5 cycles of PIPAC with low-dose cisplatin and doxorubicin showing partial tumor response according to RECIST 1.1 criteria, in particular ascites control. c Postoperative image after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). d CT scan 6 months after CRS and HIPEC showing beginning recurrence (minimal ascites and tumor node on the lateral liver surface). The patient survived 46 months after diagnosis, 25 months after first PIPAC, and 18 months after CRS and HIPEC