Skip to main content
Log in

Peritoneal mesothelioma

  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Peritoneal mesothelioma is usually a rapidly fatal primary peritoneal surface malignancy with a median survival time of less than 1 year, mainly because of lack of effective treatment. The incidence is approximately one per 1,000,000; approximately one fifth to one third of all mesotheliomas are peritoneal. Because of its unusual nature, the disease has not been clearly defined in terms of its natural history, diagnosis, or management. Treatment options with intravenous chemotherapy are far from satisfactory. However, because malignant peritoneal mesothelioma usually remains confined to the peritoneal cavity for most of its natural history, regional chemotherapy is an attractive option. From a theoretic perspective, the treatments are most likely to succeed in selected patients with small-volume residual disease after cytoreductive surgery. Advantages of intraperitoneal chemotherapy include greatly enhanced drug concentrations in the peritoneal cavity and decreased systemic toxicity. In designing an intraperitoneal treatment strategy for the management of peritoneal mesothelioma, the limited number of active cytotoxic drugs and the timing of drug delivery pose problems. Prognosis as determined by clinical presentation, the completeness of cytoreduction, and gender (female patients survive longer than male patients) appears to be improved by the use of intraperitoneal chemotherapy. Over the past decade, the management of these patients has evolved similarly to ovarian cancer treatment and now involves cytoreductive surgery, heated intraoperative intraperitoneal chemotherapy with cisplatin and doxorubicin, and early postoperative intraperitoneal paclitaxel. These perioperative treatments are followed by adjuvant intraperitoneal paclitaxel and second-look cytoreduction. Prolonged disease-free survival and reduced adverse symptoms with the current management strategy are documented by a high complete response rate as assessed by a negative second look. This multimodality treatment approach with debulking surgery and intraperitoneal chemotherapy has resulted in a median survival of 50 to 60 months. Peritoneal mesothelioma is an orphan disease that is treatable, with expectations for “potential” cure in a small number of patients diagnosed and treated early with definitive local/regional treatments. A prolonged high quality of life is possible in the majority of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Price B: Analysis of current trends in United States mesothelioma incidence. Am J Epidemiol 1997, 145:211–218.

    PubMed  CAS  Google Scholar 

  2. Sridhar KS, Doria R, Raub WA Jr, et al.: New strategies are needed in diffuse malignant mesothelioma. Cancer 1992, 70:2969–2979.

    Article  PubMed  CAS  Google Scholar 

  3. Antman K, Shemin R, Ryan L, et al.: Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women’s Hospital experience over two decades, 1965–1985. J Clin Oncol 1988, 6:147–153.

    PubMed  CAS  Google Scholar 

  4. Asensio JA, Goldblatt P, Thomford NR: Primary malignant peritoneal mesothelioma: a report of seven cases and a review of the literature. Arch Surg 1990, 125:477–481.

    Google Scholar 

  5. Attanoos RL, Gibbs AR: Pathology of malignant mesothelioma. Histopathology 1997, 30:403–418.

    Article  PubMed  CAS  Google Scholar 

  6. Vidal-Jove J, Sweatman TW, Israel M, et al.: A curative approach to abdominal mesothelioma: case report and review of the literature. Reg Cancer Treat 1991, 3:269–274.

    Google Scholar 

  7. Wagner JC, Sleegs CA, Marchand P: Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province. Br J Ind Med 1960, 17:260–271.

    PubMed  CAS  Google Scholar 

  8. Bocchetta M, Di Resta I, Powers A, et al.: Human mesothelial cells are unusually susceptible to simian virus 40-mediated transformation and asbestos cocarcinogenicity. Proc Natl Acad Sci U S A 2000, 97:10214–10219.

    Article  PubMed  CAS  Google Scholar 

  9. Gilks B, Hegedus C, Freeman H, et al.: Malignant peritoneal mesothelioma after remote abdominal radiation. Cancer 1988, 61: 2019–2021.

    Article  PubMed  CAS  Google Scholar 

  10. Peterson JT, Greenberg SD, Buffler PA: Non-asbestos related malignant mesothelioma. Cancer 1984, 54:951–960.

    Article  PubMed  Google Scholar 

  11. Roushdy-Hammady I, Siegel J, Emri S, et al.: Genetic susceptibility factor and malignant mesothelioma in the Cappadocian region of Turkey. Lancet 2001, 357:444–445.

    Article  PubMed  CAS  Google Scholar 

  12. Lerner HJ, Schoenfeld DA, Martin A, et al.: Malignant mesothelioma: the Eastern Cooperative Oncology Group (ECOG) experience. Cancer 1983, 52:1981–1985.

    Article  PubMed  CAS  Google Scholar 

  13. Markman M: Intraperitoneal therapy in the management of peritoneal mesothelioma. J Infusional Chemother 1993, 3:50–52.

    Google Scholar 

  14. Zidar BL, Pugh RP, Schieffer LM, et al.: Treatment of six cases of mesothelioma with doxorubicin and cisplatin. Cancer 1983, 52:1788–1791.

    Article  PubMed  CAS  Google Scholar 

  15. Biset D, Macbeth FR, Cram I: The role of palliative radiotherapy in malignant mesothelioma. Clin Oncol 1991, 3:315–317.

    Article  Google Scholar 

  16. Sugarbaker PH, Yan H, Grazi R, et al.: Early localized peritoneal mesothelioma as an incidental finding at laparoscopy: report of a case and implications regarding natural history of the disease. Cancer 2000, 89:1279–1284.

    Article  PubMed  CAS  Google Scholar 

  17. Chailleux E, Dabouis G, Pioche D, et al.: Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients. Chest 1988, 93:159–62.

    PubMed  CAS  Google Scholar 

  18. Markman M, Kelsen D: Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma. J Cancer Res Clin Oncol 1992, 118: 547–550.

    Article  PubMed  CAS  Google Scholar 

  19. Yates DH, Corrin B, Stidolph PN, et al.: Malignant mesothelioma in southwest England: clinicopathological experience of 272 cases. Thorax 1997, 52:507–512.

    Article  PubMed  CAS  Google Scholar 

  20. Neumann V, Muller KM, Fischer M: Peritoneal mesothelioma-incidence and etiology. Pathologie 1999, 20:169–176.

    Article  CAS  Google Scholar 

  21. Eltabbakh GH, Piver MS, Hempling RH, et al.: Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma. J Surg Oncol 1999, 70:6–12.

    Article  PubMed  CAS  Google Scholar 

  22. Park BJ, Alexander HR, Libutti SK, et al.: Treatment of primary peritoneal mesothelioma by continuous hyperthermic peritoneal perfusion (CHPP). Ann Surg Oncol 1999, 6:582–590.

    Article  PubMed  CAS  Google Scholar 

  23. Sugarbaker PH, Acherman YIZ, Gonzalez-Moreno S, et al.: Diagnosis and treatment of peritoneal mesothelioma: the Washington Cancer Institute Experi-ence. Semin Oncol 2002, 29:51–61.

    Article  PubMed  Google Scholar 

  24. Averbach AM, Sugarbaker PH: Peritoneal mesothelioma treatment approach based on natural history. Cancer Treat Res 1996, 81: 193–211.

    Google Scholar 

  25. Sebbag G, Yan H, Shmookler BM, et al.: Results of treatment of 33 patients with peritoneal mesothelioma. Br J Surg 2000, 87:1–7.

    Article  Google Scholar 

  26. Markman M, Rowinsky E, Hakes T, et al.: Phase 1 trial of intraperitoneal Taxol: a Gynecologic Oncology Group study. J Clin Oncol 1992, 10: 1485–1491.

    PubMed  CAS  Google Scholar 

  27. Markman M, Francis P, Rowisky E, et al.: Intraperitoneal Taxol (paclitaxel) in the management of ovarian cancer. Ann Oncol 1994, 5:S55-S58.

    PubMed  Google Scholar 

  28. Stephens AD, Alderman R, Chang D, et al.: Morbidity and mortality of 200 treatments with cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol 1999, 6:790–796.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mohamed, F., Sugarbaker, P.H. Peritoneal mesothelioma. Curr. Treat. Options in Oncol. 3, 375–386 (2002). https://doi.org/10.1007/s11864-002-0003-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-002-0003-6

Keywords

Navigation