Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience

Our plain-English summary of Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience, by J. Wong, A.L. Koch, J.L. Deneve, et al (Annals of Surgical Oncology, 2014).

The study

• Authors: J. Wong, A.L. Koch, J.L. Deneve, W. Fulp, T. Tanvetyanon, S. Dessureault
• Journal: Annals of Surgical Oncology
• Published: 2014;21(5):1480-6
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Cytoreduction with heated intraperitoneal chemotherapy (HIPEC) has demonstrated improved overall survival (OS) in malignant peritoneal mesothelioma (MPM). The role of repeated HIPEC for MPM is less clear.

Methods: An institutional review board-approved database of MPM patients was analyzed for clinical factors and outcomes.

Results: From June 2004 to March 2012, 29 patients underwent surgical treatment for mesothelioma. HIPEC was aborted in 3 and completed in 26; 8 underwent additional repeat HIPEC. The majority was male (62 %), median age 66 years. There was no significant difference in surgery duration, blood loss, or hospital-stay-duration between initial and repeat HIPEC. Cisplatin was the chemotherapy used. Complications occurred in 17 (65 %) initial and 6 (50 %) repeat HIPEC, with wound complications being most common. Reoperation was less common (4 % initial and 25 % repeat), and perioperative death was rare (4 % initial, 0 % repeat). Fourteen (54 %) initial and seven (58 %) repeat HIPEC patients received adjuvant chemotherapy. Median time from HIPEC to initiation of chemotherapy was not different between initial and repeat HIPEC (8.8 and 4.6 months, respectively, p = 0.68). Median treatment-free time (time from initial to repeat HIPEC or chemotherapy) also was not different between initial and repeat HIPEC (8.8 and 6.3 months, respectively, p = 0.92). Median OS for the cohort was 41.2 months. Patients who underwent repeat HIPEC had improved median OS (80 months) versus single HIPEC (27.2 months; p = 0.007). A lower peritoneal carcinoma index and complete cytoreduction were associated positively with OS.

Conclusions: Cytoreduction and HIPEC for MPM are associated with longer OS. Patients who are candidates for repeat HIPEC may derive an even greater OS advantage.

In plain English

This study reviewed records from one U.S. cancer center of patients with malignant peritoneal mesothelioma (mesothelioma of the abdominal lining) treated between June 2004 and March 2012. It was about treatment and did not look at asbestos exposure. Of 29 patients who had surgery to remove visible tumor, 26 then had heated chemotherapy (cisplatin) circulated through the abdomen, called HIPEC. Eight of these later had one or more repeat procedures, 12 repeat procedures in all. For the patients who had HIPEC, median overall survival counted from their first HIPEC was 41.2 months. Counted from the first procedure, patients who had repeat procedures had a median survival of 80 months, against 27.2 months for those who had one (p = 0.0073). Counted from the second procedure, the figure was 70.5 months, and that difference was not statistically significant. Complications followed 65% of first procedures and 50% of repeat procedures. The authors concluded that a survival benefit was seen in patients who had multiple procedures. They noted that the study was small and retrospective, and that bias was possible because repeat surgery was offered only to patients in good condition.

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 review of a single institution's database of treated patients (case series comparing single versus repeat procedures)
• Who was studied: 29 patients with biopsy-proven malignant peritoneal mesothelioma treated with cytoreductive surgery at Moffitt Cancer Center, Tampa, Florida, June 2004 to March 2012. HIPEC was completed in 26 and aborted in 3. 8 of the 26 had one or more repeat HIPEC procedures (12 repeat procedures in total). 18 (62%) were male.
• Exposure: No asbestos exposure was studied. The study examined treatment: cytoreductive surgery followed by heated intraperitoneal chemotherapy with cisplatin (250 mg/m2) circulated for 90 minutes, then early postoperative intraperitoneal chemotherapy with Taxol and 5-fluorouracil. Single and repeat procedures were compared.
• Main results:
  • Eight of the 26 patients who had HIPEC (31%) underwent one or more repeat HIPEC procedures.
  • Median overall survival for the cohort was 41.2 months. Overall survival was calculated from the date of first HIPEC, so the figure applies to the patients who had HIPEC.
  • Measured from the first HIPEC, median overall survival was 80 months in patients with multiple HIPEC versus 27.2 months in patients with a single HIPEC (p = 0.0073).
  • Measured from the second HIPEC for the multiple-procedure group, median overall survival was 70.5 months versus 27.2 months for single HIPEC. This difference was not statistically significant (p = 0.11).
  • In multivariate analysis, only a peritoneal carcinoma index of 20 or more was significantly associated with worse overall survival (hazard ratio 8.02, p = 0.0495).
  • Postoperative complications occurred in 17 (65%) of 26 initial procedures and 6 (50%) of 12 repeat procedures (p = 0.483). The text labels these as single versus multiple HIPEC groups.
  • Reoperation was needed after 3 (25%) repeat procedures versus 1 (4%) initial procedure. This difference was not statistically significant.
  • There were no 30-day deaths after repeat procedures and one (4%) after initial HIPEC.
  • Median follow-up was 12.2 months (range 1.4 to 53.8) for single-HIPEC patients and 56.7 months (range 23 to 93.1) for repeat-HIPEC patients.
• The authors' conclusion: The authors concluded that, despite the small cohort, a survival benefit was demonstrated in those who underwent multiple procedures, with no increase in complications for repeat procedures.
• Limitations the authors state:
  • The study was retrospective and small.
  • Patient selection bias was possible, since only patients with strong performance status may be offered repeat procedures.
  • Confounding was possible from the many different chemotherapy regimens used.

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: Cytoreductive Surgery, Chemotherapy, Mesothelioma, HIPEC, Overall Survival, Peritoneal Mesothelioma, Cisplatin, Carcinoma.

Related studies

• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Asian patients: 100 consecutive patients in a single institution — M.C. Teo, G.H. Tan, et al. (2013)
• Outcomes of Cytoreductive Surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients older than 70 years; survival benefit at considerable morbidity and mortality — K.I. Votanopoulos, N.A. Newman, et al. (2013)
• 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)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in pediatric patients with peritoneal mesothelioma: a single institution experience and long term follow up — P. Malekzadeh, M. Good, et al. (2021)
• Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites — R.W. Randle, K.R. Swett, et al. (2014)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)

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