Malignant Peritoneal Mesothelioma: Treatment Options and Survival

Our plain-English summary of Malignant Peritoneal Mesothelioma: Treatment Options and Survival, by S.A.S. Salo, I. Ilonen, S. Laaksonen, et al (Anticancer Research, 2019).

The study

• Authors: S.A.S. Salo, I. Ilonen, S. Laaksonen, M. Myllärniemi, J.A. Salo, T. Rantanen
• Journal: Anticancer Research
• Published: 2019;39(2):839-845
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant peritoneal mesothelioma (MPeM) is a rare type of cancer with a poor prognosis. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival. Treatment and survival of patients with MPeM have not been previously studied in Finland.

Materials And Methods: The data consisted of all patients diagnosed with MPeM during years 2000-2012 in Finland, including cancer notifications, death certificates and information about asbestos exposure.

Results: Among 50/94 (53.2%) patients treated for MPeM, 44/50 (88.0%) were treated palliatively, 4/50 (8.0%) with radical surgery and chemotherapy, and 2/50 (4.0%) with CRS plus HIPEC. Five-year survival was 50.0% for those treated with CRS plus HIPEC and 75.0% for those treated with radical surgery and chemotherapy. Radical surgery with chemotherapy was associated with significantly longer survival compared to radiation (p=0.008), chemotherapy and radiation (p=0.043), surgery, chemotherapy and radiation (p=0.039), and palliative surgery (p=0.009).

Conclusion: Treatment of MPeM is heterogenic in Finland. CRS plus HIPEC, and radical surgery with chemotherapy seem to increase the survival. Patients considered candidates for radical surgery should be sent to specialized centers for further assessment.

Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

In plain English

This retrospective study looked at every patient in Finland diagnosed with malignant peritoneal mesothelioma (cancer of the abdominal lining) between 2000 and 2012, using national registries and hospital records. Of 94 patients diagnosed, 50 received surgery, chemotherapy or radiation and were studied. Forty had only palliative or no treatment, and 4 turned out not to have primary peritoneal mesothelioma. Chemotherapy alone was the most common treatment (24 of 50). Four patients had radical surgery with chemotherapy: their median survival was 62 months, and 75.0% were alive at five years. Two had cytoreductive surgery with heated chemotherapy inside the abdomen (CRS plus HIPEC): median survival was 40 months and 50.0% were alive at five years, which was not significantly better than other treatments. Among 32 patients with a known asbestos history, the text reports 7 as exposed, though a table lists 11. Exposed patients had a median survival of 8 months, compared with 40 months for those not exposed (p=0.025). The authors concluded that these radical treatments seem to increase long-term survival. They named the small numbers and the retrospective design as limitations.

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: Retrospective nationwide study of treatments and survival, using registry data and medical records
• Who was studied: All patients diagnosed with malignant peritoneal mesothelioma in Finland from 1 January 2000 to 31 December 2012: 94 diagnosed in total. The 50 who received operative, chemotherapy or radiation treatment (33 men, 17 women; median age 61.5 years) were analysed. Forty untreated or palliative-only patients and 4 without primary peritoneal mesothelioma were excluded.
• Exposure: The main factors compared were first-line treatments: chemotherapy, radiation (12 to 30 Gy), chemotherapy with radiation, palliative surgery, radical surgery with chemotherapy, and CRS plus HIPEC. Previous asbestos exposure (yes or no) was taken from National Workers' Compensation Center records. No fiber types or doses are given.
• Main results:
  • First-line chemotherapy was the most used treatment (24 of 50 patients, per Table II).
  • Radical surgery with chemotherapy (4 patients) had a median survival of 62 months. It was related to longer survival than radiation (p=0.008), chemotherapy with radiation (p=0.043), palliative surgery with chemotherapy and radiation (p=0.039), and palliative surgery (p=0.009).
  • Five-year survival was 50.0% for patients with radical surgery plus HIPEC (2 patients) and 75.0% for radical surgery without HIPEC (4 patients).
  • CRS with HIPEC (median survival 40 months) was not significantly associated with better survival than other treatments.
  • Among patients given systemic chemotherapy, 79.2% were alive at 6 months, but long-term survival was not extended.
  • Histological subtype was known for 25 of 50 patients. Median survival was 9 months for epithelial (19 of 25), 1 month for sarcomatoid (2 of 25) and 2 months for biphasic (4 of 25). The epithelial subtype was associated with better survival than the sarcomatoid subtype (p=0.039).
  • Asbestos history was known for 32 of 50 patients, of whom 7 of 32 (21.9%) were reported as exposed. Median survival was 8 months (range 2-58) for exposed patients and 40 months (range 1-92) for unexposed patients. Asbestos exposure was associated with worse survival (p=0.025).
  • There was no statistically significant association between sex and treatment given (p=0.090), or between sex and survival (p=0.402).
  • Survival was not significantly associated with how far the disease had spread (known for 32 of 50 patients).
• The authors' conclusion: The authors concluded that CRS with HIPEC, and radical surgery with chemotherapy, seem to increase long-term survival. They also concluded that patients considered candidates for radical surgery should be sent to specialized centers for assessment.
• Limitations the authors state:
  • The study was retrospective and included a relatively small number of patients.
  • The small number of patients in each treatment group may cause statistical bias when treatments are compared.
  • The small number of patients in each histological subtype may have biased the subtype results.
  • Few patients had CRS plus HIPEC, because the procedure was not performed in Finland until 2007.

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Prognosis, Cytoreductive Surgery, HIPEC, Death Certificate, Asbestos Exposure, Chemotherapy, Palliative Care.

Related studies

• 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)
• Malignant Peritoneal Mesothelioma: National Practice Patterns, Outcomes, and Predictors of Survival — V. Verma, R.L. Sleightholm, et al. (2018)
• 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)
• Long-term Survival and Propensity Score Matched Outcomes of Bilateral vs. Unilateral Diaphragm Interventions in Cytoreductive Surgery plus Intra-peritoneal Chemotherapy — B. Singh, G. Singh, et al. (2018)
• Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma — H.R. Alexander, D.L. Bartlett, et al. (2013)
• Evolution of locoregional treatment for peritoneal carcinomatosis: single-center experience of 308 procedures of cytoreductive surgery and perioperative intraperitoneal chemotherapy — T.C. Chua, W. Liauw, et al. (2011)

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