Diffuse malignant peritoneal mesothelioma--an update on treatment

Our plain-English summary of Diffuse malignant peritoneal mesothelioma--an update on treatment, by P. Mirarabshahii, K. Pillai, T.C. Chua, et al (Cancer Treatment Reviews, 2012).

The study

• Authors: P. Mirarabshahii, K. Pillai, T.C. Chua, M.H. Pourgholami, D.L. Morris
• Journal: Cancer Treatment Reviews
• Published: 2012;38(6):605-12
• Type of article: Review
• Cited by: 65 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesotheliomas are aggressive and lethal neoplasms arising from mesothelial cells lining the pleura, peritoneum, tunica vaginalis testis and pericardium. Malignant peritoneal mesothelioma accounts for about 30% of all mesotheliomas. Asbestos is the main known cause of the disease. Presenting symptoms in these patients include: ascites, abdominal pain, asthenia, weight loss, anorexia, abdominal mass, fever, diarrhea and vomiting. Electron microscopy, immunohistochemistry, computed tomography scan, echotomography, magnetic resonance imaging, positron emission tomography and laparoscopy are used in diagnosis and follow-up. Chemotherapy alone is considered as a palliative treatment for these patients who are not eligible for radical surgery. The most promising non-surgical approach today in the management of peritoneal mesothelioma is the use of the combination chemotherapy regime of an antifolate (pemetrexed and raltitrexed) and a platinum based (cisplatin) agent with a median survival of about 12-14 months. Due to peritoneal confinement of malignant mesothelioma and low occurrence of metastasis, a locoregional approach consisting of cytoreductive surgery and perioperative intraperitoneal chemotherapy has been introduced as a curative treatment option over the last decade with an overall 5-year survival rate of 29-63%. In this locoregional approach, surgery can separate the adhesions and remove the bulky tumor, leaving microscopic residual tumors much more susceptible to the killing effect of chemotherapeutic drugs. Here in St. George hospital, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (using cisplatin and doxorubicin) resulted in significant survival advantage. This article describes how the prognosis of the disease has changed over the last decade.

Copyright © 2011 Elsevier Ltd. All rights reserved.

In plain English

This article was a review of published research on diffuse malignant peritoneal mesothelioma (DMPM), a cancer of the lining of the abdomen. The authors work at St. George Hospital, Sydney. They searched PubMed from 1980 to March 2011 for English-language articles, focusing on treatment. They described asbestos as the main known cause, while citing a report that only 33% of patients with DMPM report a history of asbestos exposure. Drawing on other studies, they reported several survival figures. Untreated or conventionally treated patients had a life expectancy of 4 to 12 months. Combination chemotherapy with pemetrexed and cisplatin or gemcitabine gave a median survival of about 12 to 14 months. Cytoreductive surgery aims to remove as much visible tumor as possible; when it was complete and combined with intraperitoneal chemotherapy, 5-year survival reached 29 to 63%. Published complication rates were 25 to 40% and death rates 0 to 8%. A table listed 20 patients from their own hospital, with a median survival of 30 months. The authors concluded that the biggest survival gain may be attributed to combined cytoreductive surgery and heated intraperitoneal chemotherapy.

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: Narrative review of published literature, plus a description of the authors' own centre's treatment practice
• Who was studied: Published English-language studies on malignant peritoneal mesothelioma, selected for information on treatment options, methods and outcomes; also patients treated at St. George Hospital, Sydney (20 patients listed in a table)
• Exposure: The review concerned treatments (cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, systemic chemotherapy, targeted therapy). Asbestos was described as the main known cause of DMPM; no fiber types were named.
• Main results:
  • Citing other studies: only 33% of patients with DMPM report a history of asbestos exposure, and only 23% of women who develop DMPM have been exposed to asbestos
  • Citing other studies: life expectancy of untreated patients and of patients treated by conventional means was 4 to 12 months
  • Citing other studies: 5-year survival after complete cytoreductive surgery with intraperitoneal chemotherapy reached 29 to 63%
  • Citing other studies: combination chemotherapy with pemetrexed and cisplatin or gemcitabine was reported to give a median survival of about 12 to 14 months in patients not eligible for radical surgery
  • Citing a staging study from a multi-institutional registry: 5-year survival of 87%, 53% and 29% for stage I, II and III disease
  • Citing other studies: for the combined surgery and chemotherapy treatment, the complication (morbidity) rate was 25 to 40% and mortality was 0 to 8%
  • At St. George Hospital, DMPM was treated with heated intraperitoneal cisplatin (50 mg/m2) and doxorubicin (15 mg/m2) for 90 minutes. A table listed 20 patients from this hospital with a median survival of 30 months; 5-year survival was not reported.
• The authors' conclusion: The authors concluded that the biggest accomplishment in improving survival may be attributed to combined cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy, which in well selected patients may achieve a 5-year survival of 47%, as indicated in a multi-institutional registry study
• Limitations the authors state:
  • The authors noted that the rarity of the disease has limited replication of the one randomized phase III trial of pemetrexed with cisplatin
  • The authors noted that results for laparoscopic intraperitoneal chemotherapy to relieve ascites are preliminary

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, Neoplasm, Mesothelial Cells, Pleura, Peritoneum, Tunica Vaginalis, Pericardium.

Related studies

• Importance of gender in diffuse malignant peritoneal mesothelioma — C. Cao, T.D. Yan, et al. (2012)
• Primary diffuse malignant peritoneal mesothelioma: case report and update of therapy — D. Piazza, F. Caruso, et al. (2000)
• Current concepts in the evaluation and treatment of patients with diffuse malignant peritoneal mesothelioma — K. Turner, S. Varghese, et al. (2012)
• Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma — T.C. Chua, T.D. Yan, et al. (2011)
• Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma — G.H. Eltabbakh, M.S. Piver, et al. (1999)
• 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)

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