Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma

Our plain-English summary of Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma, by G.H. Eltabbakh, M.S. Piver, R.E. Hempling, et al (Journal of Surgical Oncology, 1999).

The study

• Authors: G.H. Eltabbakh, M.S. Piver, R.E. Hempling, F.O. Recio, M.E. Intengen
• Journal: Journal of Surgical Oncology
• Published: 1999;70(1):6-12
• Cited by: 112 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Objective: The clinical picture, response to therapy, and prognosis of women with diffuse malignant peritoneal mesotheliomas (DMPM) are ill defined. The purpose of this study is to report on the clinical picture, response to therapy, and survival of women with DMPM.

Methods: The study is a retrospective review of 15 women with the confirmed pathologic diagnosis of DMPM treated between 1964 and 1996. Survival curves were constructed according to the Kaplan-Meier method. The effect of different factors on survival was studied using the log-rank test. Two-tailed P values < 0.05 were considered significant.

Results: Clinical features included abdominal distension (11/15, 73%), abdominal pain (6/15, 40%), ascites (9/15, 60%), abdominal or pelvic masses (14/15, 93%), elevated CA-125 (4/4, 100%), thrombocytosis (4/ 15, 27%), and thrombo-embolic manifestations (3/15, 20%). The response rate to all first-line chemotherapy regimens was 30%. The response rate to paclitaxel/cisplatin was 66.7% and the toxicity was tolerable. The median survival of all patients was 12.5 months. Patients who underwent cytoreductive surgery survived longer than those who underwent biopsy only (median survival 13.5 vs. 6.0 months, P = 0.24). Patients who received chemotherapy survived significantly longer than those who did not receive chemotherapy (29.0 vs. 1.0 months, P = 0.03). Patients who responded to first-line chemotherapy survived significantly longer than those who did not respond (P = 0.04).

Conclusions: Cytoreductive surgery and chemotherapy, especially with paclitaxel and cisplatin, might be of benefit in women with DMPM.

In plain English

This retrospective review covered 15 women with diffuse malignant peritoneal mesothelioma (DMPM) treated at Roswell Park Cancer Institute between 1964 and 1996. All had the epithelial type. A history of asbestos exposure was recorded as yes for 3 women, no for 6 and unknown for 6. The most common symptom was abdominal distension (11 of 15). The most common finding was an abdominal or pelvic mass (14 of 15). CA-125 was elevated in all 4 women tested. Median survival for all patients was 12.5 months. Three of 10 women given first-line chemotherapy responded, including 2 of 3 given paclitaxel and cisplatin. The 10 women who received chemotherapy had a median survival of 29.0 months, against 1.0 month for the 5 who did not (P = 0.03). Women who had tumor-reducing surgery had a median survival of 13.5 months, against 6.0 months after biopsy only. That difference was not statistically significant (P = 0.24). The authors concluded that cytoreductive surgery and chemotherapy, especially paclitaxel and cisplatin, might benefit these women. They noted that the numbers were too small for meaningful conclusions about that drug combination.

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: retrospective review of patient records (clinicopathologic analysis) at one cancer center
• Who was studied: 15 women with pathologically confirmed DMPM (all epithelial type) treated at Roswell Park Cancer Institute, Buffalo, New York, between 1964 and 1996; median age 63 (range 27 to 86); 14 White, 1 Native American
• Exposure: The study examined treatments (surgery, chemotherapy including paclitaxel and cisplatin) rather than an exposure. History of asbestos exposure was recorded as yes for 3, no for 6 and unknown for 6 women; no fiber types are given.
• Main results:
  • Abdominal distension was the most common presenting symptom (11 of 15, 73%), and an abdominal or pelvic mass the most common clinical finding (14 of 15, 93%)
  • Preoperative CA-125 was known for 4 women, and all 4 had values above 35.0 U/ml
  • Preoperative fluid samples (paracentesis) from 4 patients were all reported as adenocarcinoma
  • Median overall survival for all 15 patients was 12.5 months
  • Response to first-line chemotherapy: 3 of 10 patients (30%) had partial or complete response; with paclitaxel and cisplatin the response rate was 66.7% (2 of 3)
  • The 10 patients who received chemotherapy had a median survival of 29.0 months, compared with 1.0 month for the 5 who did not (P = 0.03, statistically significant)
  • Patients who had cytoreductive (debulking) surgery (n = 9) had a median survival of 13.5 months, compared with 6.0 months for biopsy only (n = 6); the difference was not statistically significant (P = 0.24)
  • The 3 patients who responded to first-line chemotherapy survived 9+, 12.5+ and 168 months, compared with a median of 12.5 months for the 7 who progressed (P = 0.04)
  • Grade 3 neutropenia (low white blood cell count) occurred in 2 of the 3 patients on paclitaxel and cisplatin and in 1 patient on cyclophosphamide and cisplatin
• The authors' conclusion: The authors concluded that cytoreductive surgery and chemotherapy, especially with paclitaxel and cisplatin, might be of benefit in women with DMPM
• Limitations the authors state:
  • The authors stated that the numbers treated with paclitaxel and cisplatin were too small to make meaningful conclusions
  • The authors attributed the lack of statistical significance in the surgery comparison to the small number of patients

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, Prognosis, Ascites, CA-125, Chemotherapy, Cisplatin, Median Overall Survival, Cytoreductive Surgery.

Related studies

• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)
• Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma — T.C. Chua, T.D. Yan, et al. (2011)
• Malignant Peritoneal Mesothelioma: National Practice Patterns, Outcomes, and Predictors of Survival — V. Verma, R.L. Sleightholm, et al. (2018)
• Intraperitoneal therapy for peritoneal tumors: biophysics and clinical evidence — W.P. Ceelen, M.F. Flessner (2010)
• The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — S. Kusamura, P.A. Torres Mesa, et al. (2016)
• A novel nomogram for peritoneal mesothelioma predicts survival — N.P. Schaub, M. Alimchandani, et al. (2013)

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