Aggressive multimodality treatment for primary malignant peritoneal mesothelioma

Our plain-English summary of Aggressive multimodality treatment for primary malignant peritoneal mesothelioma, by W.C. Teoh, K.S. Haghighi, D.L. Morris (ANZ Journal of Surgery, 2001).

The study

• Authors: W.C. Teoh, K.S. Haghighi, D.L. Morris
• Journal: ANZ Journal of Surgery
• Published: 2001;71(11):683-5
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This case report described one 48-year-old man in Australia with diffuse malignant peritoneal mesothelioma, a cancer of the abdominal lining. The article reported no history of asbestos exposure. He first presented in October 1998. An early biopsy was read as mucinous adenocarcinoma, and he was referred as having pseudomyxoma peritonei. In February 1999 surgeons removed the tumour through a series of peritonectomy procedures. Five days of chemotherapy given directly into the abdomen followed (mitomycin C, then 5-fluorouracil). Tissue examination was consistent with diffuse malignant mesothelioma. Two weeks later he developed a perforated colon, then a perforated stomach, both needing further surgery. His hospital stay totalled 58 days. In October 1999 tumour was found again, and he received 13 cycles of systemic gemcitabine over 6 months. In June 2000 small deposits were removed and a port was placed for the same abdominal chemotherapy. An October 2000 scan showed no recurrence, and he was reported well 24 months after first presenting. The authors concluded that the outcome was remarkably good and that the favourable response may justify the complication rates.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 48-year-old man with diffuse malignant peritoneal mesothelioma, first seen in October 1998 and treated at St George Hospital, Kogarah, New South Wales, Australia, from February 1999
• Exposure: No asbestos exposure was reported for this patient. The article concerns treatment: peritonectomy (cytoreductive surgery), early postoperative intraperitoneal mitomycin C (10 mg/m2) and 5-fluorouracil (15 mg/kg per day), and systemic gemcitabine
• Main results:
  • The initial biopsy was described as poorly differentiated mucinous adenocarcinoma. Later histology of the resected peritoneum was consistent with diffuse malignant mesothelioma.
  • Intraperitoneal mitomycin C was instilled after surgery and followed by daily intraperitoneal 5-fluorouracil over the next 4 days.
  • Two weeks after surgery the patient developed peritonitis from a perforated transverse colon, later followed by a gastric perforation. Total hospitalization was 58 days.
  • In October 1999 tumour seeding was found on the peritoneum and small bowel mesentery. Histology showed malignant mesothelioma, and the patient was treated with 13 cycles of systemic gemcitabine over 6 months.
  • In June 2000 a few small tumour deposits were excised. An intraperitoneal port was inserted for administration of mitomycin C and 5-fluorouracil using the same protocol as before.
  • A CT scan in October 2000 showed no evidence of disease recurrence, and the patient was well 24 months after initial presentation.
• The authors' conclusion: The authors concluded that peritonectomy with intraperitoneal and systemic chemotherapy resulted in a remarkably good outcome in this patient. They also concluded that the favourable response may justify the complication rates of multimodality treatment, although the morbidity may deter many.
• Limitations the authors state:
  • The authors noted that morbidity like that seen in this patient may weigh against aggressive multimodality treatment.
  • The authors stated that it is difficult to extrapolate patient-selection data from other peritoneal malignancies to peritoneal mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma.

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• What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures — G. Passot, D. Vaudoyer, et al. (2016)
• Peritoneal cystic mesothelioma: are surgery and HIPEC optimal first-line treatments? — F. Coccolini, R. Manfredi, et al. (2012)
• Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups — O. Glehen, V. Kepenekian, et al. (2020)
• Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma — H.R. Alexander, D.L. Bartlett, et al. (2013)
• Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy — K.I. Votanopoulos, C. Ihemelandu, et al. (2012)

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