Peritoneal Metastases from Malignant Mesothelioma

Our plain-English summary of Peritoneal Metastases from Malignant Mesothelioma, by C.Y. Li, H.R. Alexander (Surgical Oncology Clinics of North America, 2018).

The study

• Authors: C.Y. Li, H.R. Alexander
• Journal: Surgical Oncology Clinics of North America
• Published: 2018;27(3):539-549
• Type of article: Review
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Diffuse malignant peritoneal mesothelioma (MPM) is a rare cancer that is ultimately fatal in almost all afflicted individuals. Morbidity and mortality from MPM is due to its propensity to progress locoregionally within the abdominal cavity. Patients with MPM most commonly present with nonspecific abdominal symptoms that usually lead to diagnosis when the condition is relatively advanced. MPM is considered a chemotherapy-resistant malignancy.

Copyright © 2018 Elsevier Inc. All rights reserved.

In plain English

This article is a narrative review, not a new study. The authors summarized published research on diffuse malignant peritoneal mesothelioma (MPM), a rare cancer arising from the lining of the abdomen. They covered its history, risk factors, symptoms, diagnosis, staging and treatment. Citing earlier studies, they wrote that a strong association between asbestos exposure and the disease has been known for many years, and that radiation and BAP-1 mutations have also been implicated. They cited reports that the lifetime risk of mesothelioma among asbestos workers can be as high as 10%, with latency as long as 30 years. The review reported that chemotherapy alone gave response rates of about 25% and overall survival of about 1 year. It described studies of surgery to remove tumor (cytoreduction) combined with chemotherapy delivered into the abdomen. One cited meta-analysis of 1047 patients reported 5-year survival of 42%. The authors concluded that this combined approach has become accepted as the preferred first-line treatment for selected patients. They noted that almost all available data are retrospective.

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 studies on diffuse malignant peritoneal mesothelioma; no original data or review methods described
• Who was studied: Published studies of patients with diffuse malignant peritoneal mesothelioma (MPM); the review itself studied no new patients
• Exposure: Mainly treatment (systemic chemotherapy; operative cytoreduction with HIPEC or EPIC). Asbestos exposure is discussed, citing earlier studies, as a risk factor with no fiber types named; radiation and BAP-1 mutations are also mentioned
• Main results:
  • Citing other studies, the review stated that the lifetime risk of mesothelioma among asbestos workers has been shown to be as high as 10%, with a latency period as long as 30 years
  • In a cited series of 35 patients with MPM in Turkey who received palliative chemotherapy or supportive care, multivariate analysis found that age over 60 years, asbestos exposure for more than 20 years, and poor performance status were associated with shorter survival
  • The review reported that systemic chemotherapy for MPM has response rates of approximately 25% and overall survival of approximately 1 year
  • A cited meta-analysis of 20 publications covering 1047 patients with MPM treated with operative cytoreduction reported a 5-year actuarial overall survival of 42%
  • In a cited multicenter study of 405 patients from 29 centers, median overall survival after cytoreduction and HIPEC was 53 months and 5-year overall survival was 47%
  • In a cited study of 211 patients treated at 3 US centers, median overall survival was 38 months and 5-year overall survival was 41%
  • In a cited institutional study of 100 patients who had cytoreduction and HIPEC, median survival was 13 months for those with preoperative thrombocytosis (high platelet count) and 58 months for those with normal platelet counts
  • In a cited cohort of 65 patients who had cytoreduction and HIPEC, major postoperative complications occurred in 23 patients (35%) and the 60-day mortality rate was 6%
• The authors' conclusion: The authors concluded that operative cytoreduction with regional intraperitoneal chemotherapy has become accepted as the preferred first-line treatment in selected patients with MPM
• Limitations the authors state:
  • The authors noted that almost all of the available data on cytoreduction and regional chemotherapy are retrospective
  • The authors stated that the benefit of systemic chemotherapy before or after cytoreduction and HIPEC has not been established

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: Malignant Mesothelioma, Peritoneal Mesothelioma, Chemotherapy.

Related studies

• Current Management and Future Opportunities for Peritoneal Metastases: Peritoneal Mesothelioma — H.R. Alexander, C.Y. Li, et al. (2018)
• Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases — D. Elias, D. Goéré, et al. (2014)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Peritoneal metastases from small bowel cancer: Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands — T.R. van Oudheusden, V.E. Lemmens, et al. (2015)
• The Pathologic Peritoneal Cancer Index (PCI) Strongly Differs From the Surgical PCI in Peritoneal Metastases Arising From Various Primary Tumors — A. Bhatt, Y. Yonemura, et al. (2020)
• Lymph node metastases in diffuse malignant peritoneal mesothelioma — D. Baratti, S. Kusamura, et al. (2010)

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