Diffuse malignant peritoneal mesothelioma: systematic review of clinical management and biological research

Our plain-English summary of Diffuse malignant peritoneal mesothelioma: systematic review of clinical management and biological research, by D. Baratti, S. Kusamura, M. Deraco (Journal of Surgical Oncology, 2011).

The study

• Authors: D. Baratti, S. Kusamura, M. Deraco
• Journal: Journal of Surgical Oncology
• Published: 2011;103(8):822-31
• Type of article: Systematic review
• Cited by: 53 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon and locally aggressive tumor with poor prognosis. Currently, no standard therapy is available. The biology of this disease is still poorly understood. We performed a systematic search of relevant studies on clinical management and biological research of DMPM. Trials were selected using a predetermined protocol. The current evidence suggests that cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) results in improved survival. Biological understanding of DMPM is currently evolving.

Copyright © 2011 Wiley-Liss, Inc.

In plain English

This article was a systematic review, not a new study of patients. The authors searched PubMed from January 1979 to July 2010 for articles on diffuse malignant peritoneal mesothelioma (DMPM), cancer of the abdominal lining. From 1,726 articles they selected reports on surgery to remove all visible tumor (cytoreductive surgery) combined with chemotherapy given into the abdomen. Together these covered 427 patients. They also reviewed systemic chemotherapy and laboratory studies. In the surgical series where median overall survival was reached, it ranged from 29.5 to 92 months. Three series had not reached it. Operative death occurred in 11 of 373 assessable patients. In the seven studies that reported it, 39 patients (30%) gave a history of asbestos exposure and 91 (70%) did not. The authors concluded that, even without controlled data, this combined approach is now the benchmark against which other treatments are evaluated. They noted that no included series had a control group and that protocols varied widely. They also noted that patients in poor condition were generally excluded, so patient selection may partly explain the results.

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: Systematic review of published studies (PubMed search, January 1, 1979 to July 31, 2010) with narrative synthesis; no meta-analysis
• Who was studied: Published case series of patients with diffuse malignant peritoneal mesothelioma. Of 1726 articles screened, 12 reports on combined treatment were selected, plus one Italian and one international multi-institutional study. These gave 427 patients from 12 institutions (US, Italy, France, Spain, Australia, UK). Systemic chemotherapy studies and basic science papers were also reviewed.
• Exposure: The review studied treatments (cytoreductive surgery with perioperative intraperitoneal chemotherapy, and systemic chemotherapy), not asbestos. Asbestos exposure history was reported in only seven of the studies. No fiber types were named.
• Main results:
  • Among patients treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy, median overall survival ranged from 29.5 to 92 months in the series where it was reached.
  • Median overall survival was not reached in three series. In one of these it was longer than 100 months.
  • The text gives 1-, 2-, 3- and 5-year overall survival rates across series as 43 to 88%, 43 to 77%, 43 to 70%, and 33 to 68%. However, the article's Table IV appears to list lower figures for two series (17% for Winston-Salem and 31% for Lyon), so the stated ranges may not match the table.
  • Operative death occurred in 11 of 373 assessable patients in the single-institution series, with rates ranging from 0 to 10.5%. The article prints the overall figure as 3.1%, but 11 of 373 works out to about 2.9%.
  • In the seven studies reporting it, 39 patients (30%) gave a history of asbestos exposure and 91 (70%) did not.
  • For systemic chemotherapy, the review reported median survival of 8.7 to 10.3 months for pemetrexed alone and 13.1 to 24 months for pemetrexed with cisplatin.
• The authors' conclusion: The authors concluded that, even in the absence of controlled data, the combined local-regional approach is now the benchmark against which other treatments are evaluated. They said novel systemic chemotherapy combinations warrant further assessment.
• Limitations the authors state:
  • None of the included studies were randomized or comparative, so meta-analysis was not possible.
  • Heated intraperitoneal chemotherapy protocols varied widely between institutions.
  • Selection bias may explain part of the apparent benefit, because patients in poor general condition are generally excluded from this treatment.
  • No staging system exists for peritoneal mesothelioma, so disease stage at treatment was unclear.
  • Data came from specialized referral centers.

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, Systematic Review, Prognosis, Cytoreductive Surgery, Chemotherapy.

Related studies

• 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)
• 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)
• Lymph node metastases in diffuse malignant peritoneal mesothelioma — D. Baratti, S. Kusamura, et al. (2010)
• Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management — A.M.C. Rapisarda, A. Cianci, et al. (2018)
• 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)
• 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)

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