Efficacy of Cell-Free and Concentrated Ascites Reinfusion Therapy for Palliative Care in a Patient with Malignant Pleural Mesothelioma: A Case Report

Our plain-English summary of Efficacy of Cell-Free and Concentrated Ascites Reinfusion Therapy for Palliative Care in a Patient with Malignant Pleural Mesothelioma: A Case Report, by K. Hisakane, H. Ohmatsu, S. Umemura, et al (Journal of Nippon Medical School = Nippon Ika Daigaku Zasshi, 2017).

The study

• Authors: K. Hisakane, H. Ohmatsu, S. Umemura, K. Kirita, S. Matsumoto, K. Yoh, S. Niho, K. Goto
• Journal: Journal of Nippon Medical School = Nippon Ika Daigaku Zasshi
• Published: 2017;84(5):231-236
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Cell-free and concentrated ascites reinfusion therapy (CART) is recognized as a useful treatment to improve the symptoms caused by refractory ascites. Recently, a few clinical studies have reported the effects of CART for malignant ascites, especially in gynecological and gastrointestinal cancers. We report the case of malignant ascites in a patient with malignant pleural mesothelioma (MPM) whose symptoms were relieved by CART. A 59-year-old Japanese male with MPM who had undergone pleural decortication had pleural and peritoneal recurrence. His general status deteriorated as he developed massive ascites due to peritoneal metastases. With the initiation of CART, he recovered well enough to receive cisplatin-based systemic chemotherapy. Repeated use of CART contributed to the maintenance of his good general condition and enabled him to undergo successive systemic chemotherapy, which might have lengthened his life. This is the first report that demonstrates the efficacy of CART for palliative care in a patient with MPM. Our experience indicates that CART should be considered as a treatment option to control refractory malignant ascites regardless of the type of cancer.

In plain English

This case report described one patient. He was a 59-year-old Japanese man with malignant pleural mesothelioma of the epithelioid type who had worked for fourteen years demolishing houses, with occupational exposure to asbestos. The article does not name a fiber type. After chemotherapy and surgery on the right pleura, his cancer returned in the pleura and spread in the lining of the abdomen, and massive fluid built up in his abdomen (ascites). Diuretics and repeated drainage did not improve his condition. Doctors then used CART, in which drained fluid is filtered to remove cells, concentrated, and returned through a vein. The first session drained 4.5 L and was followed by a fever of 39.6°C. The second drained 5.3 L. His symptoms improved, and he was able to receive cisplatin and pemetrexed chemotherapy. The ascites later disappeared on CT but gradually returned, and CART was repeated for symptom relief. He died at home 3 months after his last chemotherapy. The authors concluded that CART relieved his symptoms and that repeated CART with chemotherapy may contribute to longer survival. As a single case, the report describes one patient's course without a comparison group.

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 (one patient)
• Who was studied: one 59-year-old Japanese man with malignant pleural mesothelioma (epithelioid), a former smoker, treated at National Cancer Center Hospital East, Chiba, Japan
• Exposure: occupational asbestos exposure from fourteen years of house demolition work; fiber type not stated. The treatment studied was cell-free and concentrated ascites reinfusion therapy (CART) together with cisplatin and pemetrexed chemotherapy
• Main results:
  • In the first CART, 4.5 L of ascites was collected and concentrated to 0.4 L
  • The patient's body temperature rose to 39.6°C after the first reinfusion; the authors described this as grade 2 fever, managed with a corticosteroid
  • In the second CART, 5.3 L of ascites was collected and concentrated to 0.65 L
  • The patient's abdominal distention, appetite loss and fatigue improved, and he was able to receive cisplatin and pemetrexed chemotherapy
  • The patient's serum albumin levels and renal function did not deteriorate during chemotherapy
  • Three months after the second chemotherapy cycle, CT showed slightly increased pleural dissemination, but the ascites had disappeared
  • No additional abdominal puncture was needed for approximately 7 months, starting four weeks after the second chemotherapy cycle
  • No other clinically significant adverse events were observed besides the fever
  • The ascites later returned and CART was repeated for symptom relief. After 6 more chemotherapy cycles, the patient received best supportive care and died at home 3 months after the last course of chemotherapy
• The authors' conclusion: The authors concluded that CART effectively relieved symptoms of massive ascites in this patient with malignant pleural mesothelioma, and that repeated CART together with systemic chemotherapy may contribute to prolonged survival in such patients

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Ascites, Palliative Care, Pleural Mesothelioma, Cisplatin, Chemotherapy.

Related studies

• Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma? — I. Zahid, S. Sharif, et al. (2011)
• The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience — L. Orgiano, F. Pani, et al. (2016)
• Recombinant human endostatin (endostar) decreased recurrent ascites, pleural fluid and ascitic VEGF in a case of advanced mesothelioma — X. Chen, Y. Liu, et al. (2012)
• Symptom burden in mesothelioma patients admitted to home palliative care — S. Mercadante, D. Degiovanni, et al. (2016)
• Nonselective transarterial chemoperfusion: a palliative treatment for malignant pleural mesothelioma — T.J. Vogl, S. Lindemayr, et al. (2013)
• Combination of cisplatin and lurbinectedin as palliative chemotherapy in progressive malignant pleural mesothelioma: Report of two cases — Y. Metaxas, R. Cathomas, et al. (2016)

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