Early peritoneal mesothelioma: a treatable malignancy

Our plain-English summary of Early peritoneal mesothelioma: a treatable malignancy, by K.H. Antman, R.T. Osteen, K.L. Klegar, et al (Lancet, 1985).

The study

• Authors: K.H. Antman, R.T. Osteen, K.L. Klegar, D.A. Amato, E.A. Pomfret, D.A. Larson, J.M. Corson
• Journal: Lancet
• Published: 1985;2(8462):977-81
• Cited by: 82 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004224).

Abstract

37 patients with malignant peritoneal mesothelioma were studied to assess the efficacy of combined therapy. 14 patients presented after 1982. Of 6 patients treated intensively, all remain alive with no evidence of disease by computed tomographic scan at 9-36 months. Of 8 patients treated palliatively, 5 are dead. (5 had stable disease, 1 has progressed despite all treatment, and 2 were not treated.) Survival of the intensively treated group is significantly better than that of other stage I patients in this series. Patients under 40 had a significantly better survival rate than older patients.

In plain English

This article reported 37 patients with malignant peritoneal mesothelioma at two Boston hospitals from 1965 to 1984, mainly 14 diagnosed 1982 to 1984. Six with limited stage I disease had surgery, then doxorubicin and cisplatin into the abdomen; 2 with gross disease left after surgery first had intravenous chemotherapy and further surgery. Five of the 6 had whole abdominal radiotherapy; the sixth had earlier received abdominal radiotherapy for Hodgkin's disease. Eight with bulky or advanced disease were treated palliatively; 2 received no chemotherapy. All 6 intensively treated patients were alive without evidence of disease on CT scan at 9 to 34 months. Five of the 8 palliatively treated patients died, 9 to 36 months after diagnosis. The intensive group survived significantly longer than the other stage I patients. Patients under 40 lived longer than older patients. The authors noted that 4 patients had identifiable asbestos exposure, in a passage about the 8 aged 40 or under, without saying which group this count covered. They concluded that many early stage I tumours may respond to chemotherapy, noting that proof of longer survival needs a randomised study.

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: Sequential case series from two hospitals. Patients before 1978 were reviewed retrospectively, and later patients were entered prospectively on a register. Survival was compared between treatment groups using Kaplan-Meier estimates and the log rank test.
• Who was studied: 37 patients with histologically proven malignant peritoneal mesothelioma seen at the Dana-Farber Cancer Institute or Brigham and Women's Hospital, Boston, between 1965 and 1984. The main focus was 14 patients (8 men, 6 women, aged 15 to 75 years) diagnosed from 1982 to 1984 (group 3).
• Exposure: The study was about treatment, not about how the disease was caused. Intensive therapy (group 3a) was cytoreductive surgery and ten treatments of doxorubicin and cisplatin given into the abdomen. Two of the 6 had gross disease left after their first operation, so they first received intravenous chemotherapy, then further surgery before chemotherapy into the abdomen. Five of the 6 then received at least 30 Gy whole abdominal radiotherapy. Group 3b received palliative intravenous or intraperitoneal chemotherapy. On asbestos, the authors stated that 4 patients had an identifiable exposure, in a passage about the 8 group 3 patients aged 40 or under. It is not clear whether that count refers to those 8 or to all 14 group 3 patients. They also said 2 patients reported only that their schools had been cited for excessive asbestos levels. No fiber types were named.
• Main results:
  • All 6 intensively treated patients (group 3a) were alive with no evidence of disease by CT scan, at 9 to 34 months.
  • Two of the 6 intensively treated patients had gross disease after their first surgery. They received intravenous chemotherapy first, and after a documented response had further surgery and a device placed for chemotherapy into the abdomen.
  • Five of the 6 intensively treated patients received at least 30 Gy whole abdominal radiotherapy. The sixth had previously received abdominal radiotherapy for Hodgkin's disease and could not receive more.
  • Of the 8 palliatively treated patients (group 3b), 3 were alive at 1, 10 and 16 months. The other 5 died between 9 and 36 months after diagnosis.
  • Survival of the intensively treated group was significantly better than that of the other stage I patients in the series.
  • Age was the only other characteristic that appeared to affect survival. Patients under 40 lived longer than those aged 40 or over.
  • Only 1 of the 23 patients who presented between 1965 and 1982 was a long-term survivor. That patient was also under 40 at diagnosis.
  • Patients with sarcomatous or mixed tumour types tended to live longer in this series, unlike in survival analyses reported by others.
  • Side-effects in this group included one case of life-threatening Salmonella diarrhoea, an allergic reaction to intraperitoneal cisplatin, and Staphylococcus aureus peritonitis.
• The authors' conclusion: The authors concluded that a considerable percentage of early stage I peritoneal mesotheliomas may respond to chemotherapy after careful assessment by second-look laparotomy, unlike the lower response rate in bulky disease. They also concluded that intensive combined treatment can achieve substantial palliation.
• Limitations the authors state:
  • The series was small, so characteristics with small or moderate effects on survival were unlikely to be detected.
  • Proving that intensive treatment prolongs survival would require a randomised study, which the authors said would be difficult with such an uncommon tumour.
  • The intensively treated patients were a selected group with low-stage disease. The authors addressed this by comparing them only with the other stage I patients.

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.

Related studies

• Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1,000 patients — E.A. Levine, J.H. Stewart, et al. (2014)
• What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures — G. Passot, D. Vaudoyer, et al. (2016)
• Evaluation of the cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy program — T.C. Chua, S. Martin, et al. (2010)
• Risk of definitive stoma after surgery for peritoneal malignancy in 958 patients: comparative study between complete cytoreductive surgery and maximal tumor debulking — S. Riss, K. Chandrakumaran, et al. (2015)
• Peritoneal mesothelioma: natural history and response to chemotherapy — K.H. Antman, E.A. Pomfret, et al. (1983)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)

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