Current management strategies for peritoneal mesothelioma

Our plain-English summary of Current management strategies for peritoneal mesothelioma, by K.K. Turaga, M. Deraco, H.R. Alexander (International Journal of Hyperthermia, 2017).

The study

• Authors: K.K. Turaga, M. Deraco, H.R. Alexander
• Journal: International Journal of Hyperthermia
• Published: 2017;33(5):579-581
• Type of article: Review
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesothelioma of the peritoneum is a distinct entity that requires multidisciplinary care to improve oncological outcomes. In this article, we review the current management strategies discussed at the PSOGI meeting in Washington DC 2016 and provide evidence based recommendations for diagnosis and management of this disease.

In plain English

This short article was a review, not a new study. It summarized strategies for managing peritoneal mesothelioma (mesothelioma of the abdominal lining) that were discussed at a roundtable at the Peritoneal Surface Oncology Group International (PSOGI) meeting in Washington D.C. in 2016, and it set out ten recommendations. No new patients were studied. The authors recommended asking patients about asbestos exposure, previous radiation and smoking, and considering BAP-1 germline testing for families with clustering of disease. They wrote that earlier work had established asbestos as a cause of the disease, but that not all patients report past exposure. Other recommendations were that an expert pathologist review the diagnosis and that patients be evaluated at a specialty centre. Patients with resectable malignant epithelioid mesothelioma should be offered cytoreductive surgery (removing visible tumour) with HIPEC (heated chemotherapy delivered into the abdomen), and all patients should be considered for clinical trials or registries. The authors stated that the effectiveness of adjuvant chemotherapy is currently unknown. They concluded by recommending multidisciplinary management, which they said may offer improved outcomes.

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: Review summarizing expert roundtable recommendations (no original patient data)
• Who was studied: No study population. The recommendations concern patients with peritoneal mesothelioma and were based on a roundtable at the PSOGI meeting in Washington D.C. in 2016.
• Exposure: Not studied directly. The authors recommended that asbestos exposure, previous radiation and smoking be ascertained when taking a patient's history.
• Main results:
  • The authors recommended considering BAP-1 germline testing for families with clustering of disease.
  • Citing an earlier international ecological analysis (Lin et al., 2007), the authors wrote that increasing asbestos exposure has been linked to higher rates of peritoneal mesothelioma, with a 2.2-fold increased risk per kg per year. They added that not all patients with peritoneal mesothelioma report a past history of exposure.
  • The authors recommended that an expert pathologist review the histological diagnosis.
  • The authors strongly recommended evaluation at an experienced centre. They cited earlier work showing that high-volume centres reduce peri-operative mortality and morbidity.
  • The authors recommended that patients with resectable malignant epithelioid mesothelioma be offered cytoreductive surgery and HIPEC. They cited previously published studies reporting a median survival of 40 to 90 months in these patients.
  • For well differentiated papillary and multicystic mesothelioma, the authors wrote that patients may be offered observation, cytoreduction only, or cytoreduction with HIPEC, and that the incremental benefit of HIPEC in this setting is unknown.
  • The authors wrote that patients with biphasic or sarcomatoid histology do rather poorly with surgery, although a small subset benefit, and that such patients are best served in clinical trials.
  • The authors stated that the effectiveness of adjuvant chemotherapy for malignant peritoneal mesothelioma is currently unknown.
  • The authors recommended that all patients be considered for clinical trials, registries or both.
• The authors' conclusion: The authors recommended multidisciplinary management for patients with peritoneal mesothelioma, which they said may offer improved oncological and patient-reported outcomes.

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, Mesothelioma, Peritoneum, Multidisciplinary Team.

Related studies

• Current trends in the management of malignant peritoneal mesothelioma — J.T. Miura, F.M. Johnston, et al. (2014)
• Association between hospital finances, payer mix, and complications after hyperthermic intraperitoneal chemotherapy: deficiencies in the current healthcare reimbursement system and future implications — M.H. Squires, C.A. Staley, et al. (2015)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: a systematic review and meta-analysis — J.H. Helm, J.T. Miura, et al. (2015)
• Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma — T.C. Chua, T.D. Yan, et al. (2011)
• 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)
• Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — D. Baratti, M. Vaira, et al. (2010)

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