Surgery for peritoneal mesothelioma

Our plain-English summary of Surgery for peritoneal mesothelioma, by K.M. Turner, S. Varghese, H.R. Alexander (Current Treatment Options in Oncology, 2011).

The study

• Authors: K.M. Turner, S. Varghese, H.R. Alexander
• Journal: Current Treatment Options in Oncology
• Published: 2011;12(2):189-200
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare, progressive, and ultimately fatal disease in almost all afflicted individuals. MPM is a cancer that arises diffusely from the serosa of the abdominal cavity and progresses almost exclusively in this region; understanding its characteristic tumor biology has been the reasoning behind the development of treatment strategies designed to control disease progression in the peritoneum. This principally includes operative cytoreduction and hyperthermic intra-operative perfusion of intraperitoneal chemotherapy (HIPEC). This approach has been administered either alone or in combination with early postoperative intraperitoneal chemotherapy (EPIC), or as a component of a more protracted multimodal approach employing initial debulking surgery, intraperitoneal chemotherapy, and whole abdominal radiotherapy. Median overall survivals of up to 7 years have been observed in series of patients selected for operative cytoreduction and HIPEC. Factors associated with good outcome are female gender, age less or equal to 60 years, and the ability to achieve a complete extirpation of all gross peritoneal disease. In patients with symptomatic ascites, complete palliation is achieved in almost all cases. However, this treatment strategy is not without complications and carries a morbidity of 25% and mortality up to 7%. Despite these risks, the best overall survival data have been associated with this surgical approach. At our institution, we advocate cytoreduction and HIPEC as the standard management for patients with MPM for whom operative cytoreduction appears possible and safe. We believe this treatment approach should be considered as the standard of care for patients with MPM.

In plain English

This article was a review and opinion piece by authors in departments of surgery at the University of Maryland about treating malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. It did not report a new study of its own patients. Instead it summarized published research on surgery to remove visible tumor (cytoreduction) combined with heated chemotherapy given inside the abdomen during the operation (HIPEC), and on chemotherapy drugs and radiotherapy. The authors reported that median overall survival in published series of patients treated with cytoreduction and HIPEC ranged from 34.2 to 92 months. The longest came from one series of 49 patients. They cited complication rates of 15 to 31% and death rates of 0% to 7% for this treatment across studies. They noted that, because the disease is rare, most studies came from single institutions, and that retrospective studies may have been influenced by other factors. The authors advocated cytoreduction and HIPEC as standard management when the operation appears possible and safe. Asbestos was mentioned only as background, as the most prominent risk factor, and was not studied.

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 with an expert opinion statement on treatment of malignant peritoneal mesothelioma; no new patient data
• Who was studied: Patients with malignant peritoneal mesothelioma described in published treatment series and trials from a small number of centers worldwide
• Exposure: The review concerned treatments (cytoreductive surgery with HIPEC, with or without early postoperative intraperitoneal chemotherapy, systemic chemotherapy, and whole abdominal radiotherapy), not asbestos exposure. Asbestos was mentioned only in the introduction, citing other work, as the most prominent risk factor for peritoneal mesothelioma.
• Main results:
  • Across published series, median overall survival for patients with peritoneal mesothelioma undergoing cytoreduction and HIPEC ranged from 34.2 to 92 months.
  • In the series by Feldman et al. (49 patients treated with cytoreduction and HIPEC with cisplatin), median progression-free survival was 17 months and overall survival was 92 months.
  • Across studies, complication rates (morbidity) for cytoreduction with HIPEC were between 15 and 31%. The opinion statement gave a morbidity of 25%.
  • Reported death rates (mortality) for cytoreduction with HIPEC ranged from 0% to 7%.
  • In a Columbia University study of 27 patients given a multimodal approach (debulking surgery, intraperitoneal chemotherapy, cytoreduction with HIPEC, and whole abdominal radiation), median overall survival was 70 months and the 3-year survival rate was 67%.
  • In a Wake Forest study of 38 patients, median survival was 10.8 months with mitomycin C and an estimated 40.8 months with cisplatin. The authors reported that this difference was not statistically significant.
• The authors' conclusion: The authors advocated cytoreduction and HIPEC as standard management for patients in whom the operation appears possible and safe. They stated that they believe it should be considered the standard of care for peritoneal mesothelioma.
• Limitations the authors state:
  • Because the disease is rare, most of the published surgical series were from single institutions.
  • Some of the studies reviewed were retrospective, so other factors may have influenced the apparent differences between groups.
  • There were no data supporting systemic chemotherapy before or after surgery.

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, Disease Progression, Peritoneum, Cytoreductive Surgery, Chemotherapy, HIPEC, Median Overall Survival, Ascites.

Related studies

• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Cytoreductive surgery with selective versus complete parietal peritonectomy followed by hyperthermic intraperitoneal chemotherapy in patients with diffuse malignant peritoneal mesothelioma: a controlled study — D. Baratti, S. Kusamura, et al. (2012)
• Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for malignant peritoneal mesothelioma: mitomycin versus cisplatin — A.U. Blackham, P. Shen, et al. (2010)
• Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — D. Baratti, M. Vaira, et al. (2010)
• 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)
• Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma — Y. Huang, N.A. Alzahrani, et al. (2015)

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