Peritoneal mesothelioma: current status and future directions

Our plain-English summary of Peritoneal mesothelioma: current status and future directions, by T.C. Chua, C.H. Chong, D.L. Morris (Surgical Oncology Clinics of North America, 2012).

The study

• Authors: T.C. Chua, C.H. Chong, D.L. Morris
• Journal: Surgical Oncology Clinics of North America
• Published: 2012;21(4):635-43
• Type of article: Review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peritoneal mesothelioma is a rare malignancy where life expectancy with systemic chemotherapy remains poor. Most patients with this disease are diagnosed late with extensive peritoneal disease burden leading to nausea, pain, and abdominal distention as a result of ascites and a partial bowel obstruction. A newly proposed staging system comprising elements of the tumor burden measured by the peritoneal cancer index, abdominal nodal status, and extra-abdominal metastases has been demonstrated to reliably stratify patient outcomes based on staging subgroups after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. This new staging system may form the basis of selecting patients for radical surgery and improve survival outcomes.

Copyright © 2012 Elsevier Inc. All rights reserved.

In plain English

This article was a review, not a new study. The authors described current knowledge and recent research on peritoneal mesothelioma, a cancer of the lining of the abdomen. They wrote that asbestos is recognized as a cause of mesothelioma and described a theory that inhaled fibers are coughed up and swallowed and then reach the abdomen. They did not study any exposure themselves. Summarizing other researchers' work on symptoms, diagnosis and treatment, they wrote that blood tumor markers only support a diagnosis. They described a proposed staging system built from an international registry of 294 surgically treated patients, in which 5-year survival was 87%, 53% and 29% for stages I, II and III. In a registry of 405 patients treated with cytoreductive surgery plus heated chemotherapy inside the abdomen (HIPEC), median survival was 53 months. The authors concluded that pemetrexed combined with platinum-based chemotherapy seems to be the most effective treatment when surgery is not possible. They also noted that the disease's rarity makes large trials unlikely.

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: Narrative review of published research on peritoneal mesothelioma; no new data were collected
• Who was studied: No study population of its own; the article reviewed published studies of patients with peritoneal mesothelioma, including an international multi-institutional registry (PSOGI)
• Exposure: Asbestos is discussed in general terms as a cause of mesothelioma, along with theories of how fibers reach the abdomen; no fiber types, products, jobs or doses are specified, and exposure was not studied
• Main results:
  • In the cited PSOGI registry cohort of 294 patients used to build a proposed staging system, 5-year survival after cytoreductive surgery and HIPEC was 87% for stage I, 53% for stage II and 29% for stage III (findings of the cited study, not new data)
  • In the cited PSOGI registry of 405 patients treated with cytoreductive surgery and HIPEC, overall median survival was 53 months, and 3- and 5-year survival rates were 60% and 47%
  • In the same cited registry, epithelioid tumor subtype, no lymph node metastasis, optimal cytoreduction and use of HIPEC were independently associated with a better outcome
  • In the cited Expanded Access Program of 109 patients with peritoneal mesothelioma, pemetrexed combined with cisplatin or carboplatin had a response rate of 24.1% and 1-year survival of 57.4%, compared with 12.5% and 41.5% for pemetrexed alone
  • In a cited registry subgroup of 26 patients (6.4%) with multicystic peritoneal mesothelioma (20 women, 6 men), all were alive and free of disease after cytoreduction at a median follow-up of 54 months (range 5 to 129)
  • The authors wrote that tumor markers such as CA-125 and mesothelin only support a diagnosis and lack the sensitivity and specificity needed for a diagnostic tool
• The authors' conclusion: The authors concluded that pemetrexed combined with platinum-based chemotherapy seems to be the most effective treatment for patients whose disease cannot be treated with surgery
• Limitations the authors state:
  • Because the disease is rare, the authors considered large-scale trials giving the highest level of evidence on treatment unlikely, so the evidence they reviewed rests mainly on retrospective studies

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, Life Expectancy, Chemotherapy, Ascites, Partial Bowel Obstruction, Staging, Tumor Burden, Peritoneal Cancer Index (PCI).

Related studies

• Raltitrexed: current clinical status and future directions — E. Van Cutsem, D. Cunningham, et al. (2002)
• Biomarkers in malignant pleural mesothelioma: current status and future directions — T. Ahmadzada, G. Reid, et al. (2018)
• Pemetrexed in the treatment of malignant mesothelioma: results from an expanded access program in Germany — M. Reck, R.A. Stahel, et al. (2010)
• Current practice in cytoreductive surgery and HIPEC for metastatic peritoneal disease: Spanish multicentric survey — R. Morales-Soriano, N. Esteve-Pérez, et al. (2018)
• Current Management and Future Opportunities for Peritoneal Metastases: Peritoneal Mesothelioma — H.R. Alexander, C.Y. Li, et al. (2018)
• Systemic chemotherapy with pemetrexed and cisplatin for malignant peritoneal mesothelioma: a single institution experience — G. Lainakis, F. Zagouri, et al. (2011)

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