Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with oxaliplatin for peritoneal mesothelioma: preliminary results and survival analysis

Our plain-English summary of Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with oxaliplatin for peritoneal mesothelioma: preliminary results and survival analysis, by J. Hubert, E. Thiboutot, P. Dubé, et al (Surgical Oncology, 2015).

The study

• Authors: J. Hubert, E. Thiboutot, P. Dubé, A.S. Cloutier, P. Drolet, L. Sideris
• Journal: Surgical Oncology
• Published: 2015;24(1):41-6
• Type of article: Review
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Peritoneal mesothelioma is a rare disease with poor prognosis. The present study reports single center experience with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy with oxaliplatin (HIPEC-OX) over an eight-year period.

Methods: Prospectively collected data of all consecutive patients with epithelial or multicystic peritoneal mesothelioma from August 2004 to October 2012 was analyzed. Patients with sarcomatoid or biphasic peritoneal mesothelioma were not included due to general poor prognosis. Treatment consisted in CRS and HIPEC-OX (460 mg/m(2)) at 43 °C during 30 min. For statistical analysis, Kaplan-Meier survival curves were plotted and compared using log-rank tests. Cox proportional-hazards regression model was used to analyze the influence of different variables on survival.

Results: Nineteen patients with peritoneal mesothelioma underwent laparotomy with CRS and HIPEC-OX with curative intent (15 epithelial, and 4 multicystic). Mean follow-up was 36.7 months. The estimated one-year and three-year overall survival rates were respectively 100% and 91%. The estimated one-year and three-year disease-free survival rates were respectively 77% and 50%. Complications were graded according to the Clavien-Dindo classification [1] and major complications occurred in 57% of cases. There was no postoperative mortality. Histological grade was not a prognostic factor of disease-free survival (p = 0.37).

Conclusion: When comparing survival results as well as morbidity-mortality rates, the present study shows that CRS and HIPEC-OX is a valid treatment for peritoneal mesothelioma.

Copyright © 2014 Elsevier Ltd. All rights reserved.

In plain English

This study described 19 patients with peritoneal mesothelioma (15 epithelial, 4 multicystic) treated at a Montreal hospital between August 2004 and October 2012. Each had surgery to remove visible tumor, followed by heated chemotherapy with the drug oxaliplatin circulated through the abdomen (HIPEC-OX). Patients with sarcomatoid or biphasic types were not offered this treatment. The article did not report on patients' asbestos exposure. Mean follow-up was 36.7 months. Estimated overall survival was 100% at one year and 91% at three years, and three patients died during follow-up. The results section gave estimated disease-free survival of 73% at one year and 50% at three years; the abstract gives 77% at one year. Major complications occurred in 57% of cases, and no patient died within 60 days of surgery. Five-year overall survival was 57% for epithelial and 100% for multicystic mesothelioma. None of the factors analyzed, including tumor subtype, had a statistically significant effect on disease-free survival. The authors concluded that oxaliplatin is a valid drug for this treatment. They noted that the small cohort and their patient selection limited the findings.

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: Single-center case series of consecutive treated patients, retrospectively identified from a prospectively kept database. The article is labelled 'Review' in its header but reports original patient data.
• Who was studied: 19 patients (10 men, 9 women; mean age 46) with peritoneal mesothelioma (15 epithelial, 4 multicystic) treated at Maisonneuve-Rosemont Hospital, Montreal, August 2004 to October 2012. Patients with sarcomatoid or biphasic subtypes were excluded.
• Exposure: Not an asbestos exposure study. The patients' asbestos exposure was not reported. The treatment studied was cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy with oxaliplatin (460 mg per square metre, about 42 to 43 degrees C, 30 minutes), given with intravenous 5-FU and leucovorin. Complete cytoreduction was required before HIPEC. Eight patients with epithelial mesothelioma also received chemotherapy before surgery.
• Main results:
  • All 19 patients: estimated overall survival was 100% at 1 year and 91% at 3 years. Median overall survival was not reached.
  • All 19 patients: estimated disease-free survival was 73% at 1 year and 50% at 3 years, with a median of 19.7 months (the abstract states 77% at 1 year).
  • Major complications occurred in 57% of cases: anastomotic leaks 33% (4 leaks on 12 anastomoses), hematomas 11%, intra-abdominal abscesses 11%.
  • No patient died within 60 days after surgery.
  • Three patients died during follow-up: two from peritoneal recurrence and one from visceral recurrence.
  • 5-year overall survival was 57% for epithelial mesothelioma and 100% for multicystic mesothelioma.
  • Median disease-free survival was 39.2 months for multicystic and 15.6 months for epithelial mesothelioma. The difference was not statistically significant (p = 0.37). Gender, severe complications and completeness of cytoreduction also showed no significant influence on disease-free survival.
• The authors' conclusion: The authors concluded that, comparing survival and complication and death rates, oxaliplatin is a valid drug for cytoreductive surgery plus HIPEC in peritoneal mesothelioma. The abstract phrases this as CRS and HIPEC-OX being a valid treatment.
• Limitations the authors state:
  • The small cohort did not allow the authors to confirm any prognostic factors.
  • Patient selection (treating only epithelial and multicystic subtypes) likely influenced the survival figures.
  • The favorable results may partly reflect the relatively high share of patients with the less aggressive multicystic type.

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, Prognosis, Sarcomatoid, Biphasic Mesothelioma, Laparotomy, Overall Survival.

Related studies

• Outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma and predictors of survival — S.N.S. Gilani, A. Mehta, et al. (2018)
• Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma — Y. Huang, N.A. Alzahrani, et al. (2015)
• Peritoneal metastases from small bowel cancer: Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands — T.R. van Oudheusden, V.E. Lemmens, et al. (2015)
• 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)
• Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia — A. Galan, P. Rousset, et al. (2018)
• Malignant peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is GLUT1 expression a major prognostic factor? A preliminary study — J. Hommell-Fontaine, S. Isaac, et al. (2013)

Browse return to medical research.