Therapeutic strategies for well-differentiated papillary mesothelioma of the peritoneum

Our plain-English summary of Therapeutic strategies for well-differentiated papillary mesothelioma of the peritoneum, by Y.K. Lee, H.J. Jun, J.H. Nahm, et al (Japanese Journal of Clinical Oncology, 2013).

The study

• Authors: Y.K. Lee, H.J. Jun, J.H. Nahm, T.S. Lim, J.S. Park, J.B. Ahn, S.Y. Rha, H.C. Chung, H.E. Oh, J.S. Song, W.I. Yang, H.S. Kim
• Journal: Japanese Journal of Clinical Oncology
• Published: 2013;43(10):996-1003
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Well-differentiated papillary mesothelioma is an uncommon subtype of mesothelioma with a frequently indolent course, although it occasionally manifests in a more aggressive form. To establish a treatment strategy for this rare disease, we report the clinical characteristics and outcomes of 15 patients with well-differentiated papillary mesothelioma.

Methods: All pathologically diagnosed well-differentiated papillary mesothelioma cases were reviewed between 1998 and 2012.

Results: Of the 15 cases, 8 and 7 presented with single and multiple lesions, respectively. All cases with single lesions were asymptomatic, while 4 out of the 7 cases with multiple lesions were symptomatic. After tumor excision, none of the eight single-lesion cases experienced tumor recurrence. Among the other seven cases with multiple lesions, only one patient with disseminated lesions died due to disease burden. Five patients with multiple lesions received cisplatin-based intravenous or intraperitoneal chemotherapy, with a mix of complete (n= 2) and partial (n= 2) responses observed. Of particular note, one patient receiving cisplatin and pemetrexed combination chemotherapy experienced complete tumor resolution without any serious toxicity.

Conclusions: We recommend different treatment strategies based on the disease status. If the tumor is completely resectable, an excisional biopsy seems to be sufficient. If complete resection is unavailable for the asymptomatic patient with a localized tumor extent, close follow-up is an appropriate option. When the tumor is extensive or accompanied by symptoms, chemotherapy should be strongly considered.

In plain English

This was a retrospective review of 15 patients diagnosed with well-differentiated papillary mesothelioma (WDPM) of the peritoneum, a rare subtype of mesothelioma, at two institutions in Korea between 1998 and 2012. Nine were women, and the median age was 53 years. A detailed asbestos history was available for 12 patients, and none had worked in occupations with a high likelihood of asbestos exposure. Eight patients had a single lesion and seven had multiple lesions. All eight single-lesion patients were without symptoms, had the tumor fully removed, and had no recurrence. Five patients with multiple lesions received cisplatin-based chemotherapy. Among the four whose response could be assessed, two had complete and two had partial responses. One patient died of tumor progression 9 years after diagnosis. One patient given cisplatin and pemetrexed had no serious toxicity. The authors concluded that treatment should depend on disease status, with chemotherapy strongly considered for extensive or symptomatic disease. They also reviewed 13 previously published chemotherapy-treated cases.

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 case series of patients from two institutions, with a review of previously published chemotherapy-treated cases
• Who was studied: 15 patients with pathologically confirmed peritoneal WDPM at two institutions in Korea, 1998 to 2012. Nine (60%) were women, and the median age was 53 years (range 23 to 76).
• Exposure: Not an asbestos exposure study; it looked at disease features and treatments (surgery, chemotherapy). Asbestos history was available for 12 of 15 patients, and none worked in occupations with a high likelihood of asbestos exposure. No fiber types are named.
• Main results:
  • None of the 8 patients with a single lesion had a recurrence after complete tumor excision. Six were alive and two died of other causes.
  • Patients with multiple lesions were more likely to have symptoms than those with a single lesion.
  • Among the 5 patients with multiple lesions who received chemotherapy, 4 could be evaluated: 2 had complete responses and 2 had partial responses.
  • One patient with multiple lesions, treated with intraperitoneal chemotherapy, initially had a partial response but died of tumor progression 9 years after initial diagnosis.
  • One patient treated with pemetrexed and cisplatin had no serious toxicity and completed chemotherapy without dose reduction or delay. The authors reported complete tumor resolution in this patient.
• The authors' conclusion: The authors recommended treatment strategies based on disease status, with chemotherapy considered more strongly when the tumor is extensive or causes symptoms. They suggested that cisplatin and pemetrexed may be a promising option for extensive or symptomatic WDPM.
• Limitations the authors state:
  • The authors stated that further studies with a larger sample size are needed to determine the most effective and safe treatments.

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: Well-Differentiated Papillary Mesothelioma, Peritoneum, Mesothelioma, Cisplatin, Chemotherapy, Pemetrexed (Alimta), Biopsy.

Related studies

• Well-differentiated papillary mesothelioma of the female peritoneum: a clinicopathologic study of 26 cases — A. Malpica, S. Sant'Ambrogio, et al. (2012)
• Clinicopathological Characteristics of Well-differentiated Papillary Mesothelioma of The Peritoneum: A Single-institutional Experience of 12 Cases — M. Kim, H.S. Kim (2019)
• Well-differentiated papillary mesothelioma with invasive foci — A. Churg, T. Allen, et al. (2014)
• Aberrant Pax-8 expression in well-differentiated papillary mesothelioma and malignant mesothelioma of the peritoneum: a clinicopathologic study — D. Xing, N. Banet, et al. (2018)
• Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum — R.L. Attanoos, R. Webb, et al. (2002)
• Well-differentiated papillary mesothelioma in the pelvic cavity. A case report — T. Haba, K. Wakasa, et al. (2003)

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