Malignant peritoneal mesothelioma
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This paper summarizes the author’s thoughts about the use of cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy (CS-IPHC) for treatment of peritoneal malignant mesothelioma. Pleural malignant mesotheliomas are by far more common (about ten-to thirty-fold) than the peritoneal variants (2.2 cases per 1 million in the US) . Other locations (pericardium, tunica vaginalis) are very rare. It is well known that chemotherapy for mesothelioma is largely unsatisfactory, and measurement of treatment responses can be difficult. Single agent responses are all less than 20% with currently available agents for systemically administered drugs. Multiple drug combinations are typically more toxic, and have yielded little consistent demonstrable benefit with major studies reporting median survivals consistently under a year. There is currently more attention being paid to the response category of “stable” or absence of disease progression in concert with quality of life measurements; all regimens show poor durability. With peritoneal malignant mesothelioma, malignant ascites is a common presentation and a major factor in disease-related morbidity and mortality. Interperitoneal administration of agents is attractive, but drug distribution is an issue, as are response rates and durability. Multiple treatments are required; further, all neoplasms with peritoneal dissemination are typically understaged by current radiologic tests (CT, MRI), and the variable uptake of sugar by the small bowel limits the use of positron-emission tomography (PET) imaging for peritoneal malignant mesothelioma. Also, symptoms of bowel obstruction are not uncommon, and any mechanical component of obstruction will not improve with any form of chemotherapy. The author’s approach relies on surgery to achieve the following: 1) accurate staging; 2) tumor debulking, as possible, and treatment of mechanical obstruction as well as prevention of impending obstruction by resection or bypass; and 3) preparation for the use of intra-operative hyperthermic chemotherapy perfusion. This approach has been associated with rapid clinical symptom improvement, as well as a reliable and durable resolution of ascites with a single therapy. Morbidity and mortality have been acceptable with about 27-month median survival. The inability to provide effective systemic therapy to maintain or consolidate these gains is problematic.
KeywordsPeritoneal Carcinomatosis Pleural Malignant Mesothelioma Malignant Mesothelioma Malignant Ascites Intraperitoneal Hyperthermic Chemotherapy
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References and Recommended Reading
- 5.Loggie BW, Fleming RA, McQuellon RP, et al.: Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin. Am Surg 2000, 6:561–568. This study summarizes our long-term results in treating peritoneal carcinomatosis with cytoreductive surgery and intraperitoneal hyperthermic chemotherapy. These outcomes should be compared with those reported by Sadeghi et al. .Google Scholar
- 6.Loggie BW, Perini M, Fleming RA, et al.: Treatment and prevention of malignant ascites associated with disseminated intraperitoneal malignancies by aggressive combined-modality therapy. Am Surg 1997, 2:137–143.Google Scholar
- 7.McQuellon RP, Loggie BW, Fleming RA, et al.: Quality of life after intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal carcinomatosis. Eur J Surg Oncol 2001, 27:65–73. Quality-of-life outcomes were improved after cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy.PubMedCrossRefGoogle Scholar
- 8.Sadeghi B, Arvieux C, Glehen O, et al.: Peritoneal carcinomatosis from non-gynecologic malignancies: the EVOCAPE 1 multicentric prospective study. Cancer 2000, 88:358–363. This important prospective study documents the poor outcome for traditional treatment of peritoneal carcinomatosis and peritoneal mesothelioma. Outcome is related to the extent of postsurgical tumor residual and site of origin.PubMedCrossRefGoogle Scholar
- 9.Loggie BW, Fleming RA, McQuellon RP, et al.: Prospective trial for the treatment of malignant peritoneal mesothelioma. Am Surg 2001, in press. This is a more complete report of our clinical studies on the outcomes of peritoneal mesothelioma patients who were treated with cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy.Google Scholar
- 13.ParkBJ, Alexander HR, Libutti SK, et al.: Treatment of primary peritoneal mesothelioma by continuous hyperthermic peritoneal perfusion (CHPP). Ann Surg Oncol 1999, 6:582–590. An important clinical study from the Surgery Branch of the National Institutes of Health, this paper evaluates cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with cisplatin in the treatment of peritoneal mesothelioma.PubMedCrossRefGoogle Scholar