Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in a patient with peritoneal mesothelioma and HIV infection

Our plain-English summary of Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in a patient with peritoneal mesothelioma and HIV infection, by M.R. Balestra, D. Baratti, F. Crippa, et al (Tumori, 2010).

The study

• Authors: M.R. Balestra, D. Baratti, F. Crippa, B. Laterza, S. Kusamura, M. Langer, M. Deraco
• Journal: Tumori
• Published: 2010;96(2):340-4
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: High rates of septic complications have been associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, which has been suggested as the treatment of choice for isolated peritoneal malignancies. Patients infected by the human immunodeficiency virus (HIV) are still considered at a high operative risk.

Method: A 58-year-old man with HIV infection and diffuse peritoneal mesothelioma underwent optimal cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Results: The patient experienced a complete clinical response to therapy with no adverse effect on disease course or markers for HIV (CD4 count, beta2-microglobulin, neopterin, p24 antigen, and viral load).

Conclusion: This report suggests that this innovative approach can be successfully performed also in this clinical setting. In selected patients who respond to all criteria, surgery is possible and is a safe and effective therapeutic option.

In plain English

This was a case report from the National Cancer Institute in Milan, Italy, about one 58-year-old man who had been diagnosed with HIV infection in 1994 and was later found to have diffuse malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. The article does not mention asbestos exposure or the patient's work history. He had cytoreductive surgery, in which surgeons removed all visible tumor, followed by heated chemotherapy (cisplatin and doxorubicin) circulated through the abdomen. Pathology showed a malignant epithelial mesothelioma, and 2 of 8 examined iliac lymph nodes contained cancer. After surgery he had a temporary drop in lymphocytes, pneumonia treated with antibiotics, and anemia treated with blood transfusion. He left hospital on the 22nd day after surgery. Nine months later, scans showed no evidence of progressive disease, and his lymphocyte counts were stable. The authors concluded that patients with HIV infection but without AIDS-defining criteria may have a postoperative course similar to that of uninfected patients. They said this would need to be confirmed by further observations.

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 58-year-old man with HIV infection (diagnosed 1994) and peritoneal mesothelioma, treated at the National Cancer Institute, Milan, Italy
• Exposure: Not reported: the article does not describe asbestos exposure, occupation or fiber type. The study concerns treatment, namely cytoreductive surgery plus heated intraperitoneal chemotherapy with cisplatin (200 mg) and doxorubicin (75 mg).
• Main results:
  • Disease extent scored as a peritoneal cancer index of 31, and surgery achieved removal of all visible tumor in this patient
  • Pathology showed malignant epithelial mesothelioma, with 2 of 8 examined iliac lymph nodes metastatic
  • On the fifth day after surgery the patient developed grade 3 lymphocytopenia (lymphocyte count 400/µL), which recovered on its own within 48 hours
  • On day 15 after surgery the patient had mild fever and a left lower lung opacity, treated with levofloxacin; the authors describe this as transient, manageable pneumonia
  • On day 19 after surgery the patient developed moderate anemia (Hb 7.4 g/dL) and received 2 units of blood
  • Nine months after treatment, examination and CT showed no evidence of progressive disease in this patient, no HIV-related signs had developed, and total and CD4 lymphocyte counts were stable
• The authors' conclusion: The authors concluded that patients with HIV infection but without AIDS-defining criteria may have a postoperative course after cytoreductive surgery and HIPEC similar to that of non-infected patients
• Limitations the authors state:
  • The authors state it is unclear whether the lymphocytopenia and anemia were caused by the HIPEC drugs, because their timing did not match the drugs' toxicity profile
  • The authors note their findings from one patient need confirmation by further observations

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: Cytoreductive Surgery, HIPEC, Peritoneal Mesothelioma.

Related studies

• 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)
• Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry — K.I. Votanopoulos, P. Sugarbaker, et al. (2018)
• Adjuvant dendritic cell based immunotherapy (DCBI) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma, a phase II single centre open-label clinical trial: rationale and design of the MESOPEC trial — N.L. de Boer, J.P. van Kooten, et al. (2019)
• A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma — T.P. Batista, B.J.Q. Sarmento, et al. (2017)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)

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