Peritoneal mesothelioma

Our plain-English summary of Peritoneal mesothelioma, by F. Mohamed, P.H. Sugarbaker (Current Treatment Options in Oncology, 2002).

The study

• Authors: F. Mohamed, P.H. Sugarbaker
• Journal: Current Treatment Options in Oncology
• Published: 2002;3(5):375-86
• Type of article: Review
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peritoneal mesothelioma is usually a rapidly fatal primary peritoneal surface malignancy with a median survival time of less than 1 year, mainly because of lack of effective treatment. The incidence is approximately one per 1,000,000; approximately one fifth to one third of all mesotheliomas are peritoneal. Because of its unusual nature, the disease has not been clearly defined in terms of its natural history, diagnosis, or management. Treatment options with intravenous chemotherapy are far from satisfactory. However, because malignant peritoneal mesothelioma usually remains confined to the peritoneal cavity for most of its natural history, regional chemotherapy is an attractive option. From a theoretic perspective, the treatments are most likely to succeed in selected patients with small-volume residual disease after cytoreductive surgery. Advantages of intraperitoneal chemotherapy include greatly enhanced drug concentrations in the peritoneal cavity and decreased systemic toxicity. In designing an intraperitoneal treatment strategy for the management of peritoneal mesothelioma, the limited number of active cytotoxic drugs and the timing of drug delivery pose problems. Prognosis as determined by clinical presentation, the completeness of cytoreduction, and gender (female patients survive longer than male patients) appears to be improved by the use of intraperitoneal chemotherapy. Over the past decade, the management of these patients has evolved similarly to ovarian cancer treatment and now involves cytoreductive surgery, heated intraoperative intraperitoneal chemotherapy with cisplatin and doxorubicin, and early postoperative intraperitoneal paclitaxel. These perioperative treatments are followed by adjuvant intraperitoneal paclitaxel and second-look cytoreduction. Prolonged disease-free survival and reduced adverse symptoms with the current management strategy are documented by a high complete response rate as assessed by a negative second look. This multimodality treatment approach with debulking surgery and intraperitoneal chemotherapy has resulted in a median survival of 50 to 60 months. Peritoneal mesothelioma is an orphan disease that is treatable, with expectations for "potential" cure in a small number of patients diagnosed and treated early with definitive local/regional treatments. A prolonged high quality of life is possible in the majority of patients.

In plain English

This article was a review and opinion piece on treatment options, not a new study. The authors summarized published information on peritoneal mesothelioma, a cancer of the abdominal lining. They also described their group's treatment at the Washington Cancer Institute: surgery to remove as much tumor as possible, heated cisplatin and doxorubicin placed into the abdomen during the operation, and paclitaxel placed there afterward. The authors stated that median survival was usually under one year and that intravenous chemotherapy was far from satisfactory. Citing their group's earlier report of 33 patients, they noted median survival of 35 months in the 11 who had a second-look operation versus 16 months in the other 22. They cautioned that this difference may have reflected which patients were selected. They reported a median survival of 56 months from diagnosis in their patients, but said this needed caution because of short follow-up and a small study population. The authors concluded the disease was treatable, with "potential" cure in a small number of patients diagnosed and treated early. Asbestos was mentioned only as background.

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: Review and opinion article on treatment options; no new patient data were collected
• Who was studied: No new study population. The authors surveyed published reports on patients with peritoneal mesothelioma, including earlier reports from their own group at the Washington Cancer Institute.
• Exposure: No exposure was studied. Asbestos is mentioned only as background: the article attributes rising mesothelioma incidence to asbestos exposure after World War II, citing another source.
• Main results:
  • The authors stated that peritoneal mesothelioma usually has a median survival of less than one year.
  • The authors stated that the incidence is approximately one per 1,000,000.
  • The authors stated that intravenous chemotherapy options are far from satisfactory.
  • The treatment approach described combines surgery with heated chemotherapy (cisplatin and doxorubicin) placed into the abdomen during the operation and early postoperative paclitaxel placed into the abdomen.
  • In the group's earlier report of 33 patients, median survival was 35 months in the 11 patients who had second-look surgery, compared with 16 months in the other 22 patients (P = 0.002).
  • In the authors' patients, median survival was 56 months from diagnosis, with a projected 3-year survival of approximately 60%.
  • The authors stated that the multimodality approach of debulking surgery plus chemotherapy placed into the abdomen has resulted in a median survival of 50 to 60 months.
• The authors' conclusion: The authors concluded that peritoneal mesothelioma is a treatable orphan disease, with expectations of "potential" cure in a small number of patients diagnosed and treated early.
• Limitations the authors state:
  • The authors said the survival results for their patients need to be interpreted with caution because of short follow-up and a small study population.
  • The authors said the survival advantage seen with second-look surgery may have resulted from selection of the patients who received it.

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, Median Survival, Mesothelioma, Chemotherapy, Peritoneal Cavity, Cytoreductive Surgery, Prognosis, Ovarian Cancer.

Related studies

• van Ruth S, Bronkhorst MWGA, van Coeverden F, Zoetmulder FAN. Peritoneal benign cystic mesothelioma: a case report and review of literature. Eur J Surg Oncol 2002; 28(2): 192-5 — K. Sethna, F. Mohamed, et al. (2002)
• Clinical presentation of peritoneal mesothelioma — Y.I. Acherman, L.S. Welch, et al. (2003)
• Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma — T.C. Chua, T.D. Yan, et al. (2011)
• Importance of gender in diffuse malignant peritoneal mesothelioma — C. Cao, T.D. Yan, et al. (2012)
• 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)
• Malignant peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is GLUT1 expression a major prognostic factor? A preliminary study — J. Hommell-Fontaine, S. Isaac, et al. (2013)

Browse more research in Current Treatment Options in Oncology, or return to medical research.