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Several hours before entering the theater, Braud waits in his room, looking surprisingly relaxed with a book in his hand.
It's a place where he was before. At the age of 76, Braud is about to undergo his second chemotherapy after cancer of his stomach has spread to two other organs.
But this time it's different.
He is being treated at the Georges-François Leclerc hospital in Dijon, one of seven French hospitals experimenting with intraperitoneal pressure-spray chemotherapy, or PIPAC, a technique developed in Germany in 2013.
Although still under study, aerosol chemotherapy has shown promising results against some cancers, as part of a treatment with fewer side effects that gives hope to some of the weakest patients .
Unlike traditional chemotherapy, drugs are not injected into the blood.
Instead, the patient is subjected to general anesthesia and laparoscopic treatment, whereby a small incision is made in the abdominal wall and chemotherapy is introduced into the peritoneal cavity by an aerosol spray.
A little invasive
This is a minimally invasive procedure without the normally harmful side effects badociated with circulating treatment in the blood, says David Orry, who heads the hospital's oncology surgery department.
"So you avoid loss of appetite, damage to peripheral nerves or red and white blood cells" that often require stopping treatment.
"The chemotherapy is horrible, it destroys you," Braud said, running his fingers through his short, white hair that barely pushed back two months after his first treatment.
"My fingers and toes are paralyzed, I do not feel anything," he said, grateful that it forced him to give up the hike, his pbadion.
But with PIPAC therapy, he did not experience any such side effects.
For the moment, he is on treatment every two or three weeks, alternating traditional chemotherapy and PIPAC therapy, the use of which is still under study.
& # 39; Very promising & # 39;
While he is fast asleep on the operating table, the surgeons lean over him to practice two small incisions of five centimeters in the abdomen, before inserting trocars through the two layers of the peritoneum, the membrane that envelope the internal organs.
They then inject air to artificially create a cavity, which is a prerequisite for the administration of PIPAC treatment – and that is why it is for the moment exclusively used for gynecological or digestive cancers.
"You see, Mr. Braud has several metastases on his peritoneal wall," says Orry, showing a screen showing images of laparoscopy.
"This membrane has only a few vessels, so it is very difficult to treat with blood chemotherapy, which is an added benefit of PIPAC."
Once both trocars are in place, the chemotherapy is released into the inflated cavity and left there. Surgeons, anesthetists and nurses then leave the operating room to avoid any inhalation or exposure to leaks.
After 30 minutes, the product is extracted with the help of a powerful miniature pump and the incisions are closed. After six small sutures, the operation is over. It only took two hours.
In the evening, Braud is back in his room and dines, although he must stay two more nights at the hospital because of the risks badociated with general anesthesia.
For the moment, treatment with PIPAC is only offered to palliative patients, as its efficacy has not yet been demonstrated in a large scientific study.
But the initial response to this complementary treatment was "very promising" and raised hopes, said oncologist François Ghiringhelli, who has been working on the development of PIPAC in Dijon since 2017.
Affordable treatment
And the price of treatment is reasonable, the injector costing about 25,000 euros ($ 28,000) and each operation using disposable materials worth about 2,000 euros.
This year, the Regional Center for the fight against cancer in Nantes, west of Nantes, begins a multicentric study on treatment by PIPAC, which will also participate Dijon. Preliminary results are expected within five years.
"Tomorrow, we could use this technique on patients who are less seriously ill and achieving very good curative or even preventive results," says Orry, who is clearly enthusiastic about the broader perspectives of PIPAC treatment.
"For now, we have to be careful and not sell it as a miracle cure," he admits.
Such a system could also be extended to administer other molecular treatments, potentially more effective but too dangerous to pbad into the blood.
Or it could even be developed for other types of cancer that affect the bladder or lungs, which also have similar membranes to the peritoneum.
Even though he only has two years left to live, Braud has adopted his new treatment with enthusiasm.
"With PIPAC, I have hope," he says.
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