Yes, PIPAC is generally not a standalone treatment. Systemic chemotherapy is typically administered beforehand. If tumor growth stops or the disease progresses despite systemic chemotherapy, PIPAC treatment is considered. After the PIPAC procedure, once the patient's recovery process is complete, systemic chemotherapy can be resumed. In widespread tumors, the dose of systemic chemotherapy usually cannot be increased, as this could adversely affect the patient's vital functions. For this reason, PIPAC, which offers the advantage of maximum local effect with a low dose of medication, is considered as a treatment option. When the tumor mass shrinks or is significantly eliminated thanks to PIPAC, the effectiveness of systemic chemotherapy increases. This is due to the reduction in the tumor burden that chemotherapy needs to target.