The most common sites of malignant mesothelioma are the pleura and peritoneum, but little is known about the incidence, prognosis, or treatment of patients with disease in both cavities. Previous series suggest that multimodality treatment improves overall survival for pleural or peritoneal disease, but studies typically exclude patients with disease in both cavities. Despite limitations, this investigation is the only study to broadly examine outcomes for patients with malignant mesothelioma in both the pleural and peritoneal cavities.
This study retrospectively examined 50 patients with both pleural and peritoneal mesothelioma treated with the intent to prolong survival. The primary end point was overall survival from the initial operative intervention.
The median overall survival was 33.9 months from the initial intervention. Female gender and intraperitoneal dwell chemotherapy were independent predictors of overall survival. Within 1 year after the initial diagnosis, second-cavity disease was diagnosed in 52% of the patients. The median time to the second-cavity diagnosis for those with a diagnosis 1 year after the initial diagnosis was 30 months.
Well-selected patients with both pleural and peritoneal mesothelioma have a survival benefit over palliative treatment that is comparable with that seen in single-cavity disease. The presence of disease in both cavities is not a contraindication to multimodality treatment aimed at prolonging survival, whether the disease is diagnosed synchronously or metachronously. Patients with an initial diagnosis of single cavity disease are at the highest risk for identification of second-cavity disease within the first year after diagnosis.
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Del Gobbo A, Fiori S, Gaudioso G, et al. Synchronous pleural and peritoneal malignant mesothelioma: a case report and review of literature. Int J Clin Exp Pathol. 2014;7:2484–9.
Robinson BW, Musk AW, Lake RA. Malignant mesothelioma. Lancet. 2005;366(9483):397–408.
Beebe-Dimmer JL, Fryzek JP, Yee CL, et al. Mesothelioma in the United States: a surveillance, epidemiology, and end results (SEER)-medicare investigation of treatment patterns and overall survival. Clin Epidemiol. 2016;8:743–50.
Price B, Ware A. Time trend of mesothelioma incidence in the United States and projection of future cases: an update based on SEER data for 1973 through 2005. Crit Rev Toxicol. 2009;39(7):576–88.
Leinwand JC, Chabot JA, Kluger MD. Preventing recurrence of diffuse malignant peritoneal mesothelioma. Expert Rev Anticancer Ther. 2016;16(9):989–95.
van Zandwijk N, Clarke C, Henderson D, et al. Guidelines for the diagnosis and treatment of malignant pleural mesothelioma. J Thorac Dis. 2013;5(6):E254–307.
Baratti D, Kusamura S, Deraco M. Diffuse malignant peritoneal mesothelioma: systematic review of clinical management and biological research. J Surg Oncol. 2011;103(8):822–31.
Flores RM, Zakowski M, Venkatraman E, et al. Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center. J Thorac Oncol. 2007;2(10):957–65.
Kluger MD, Taub RN, Hesdorffer M, Jin Z, Chabot JA. Two-stage operative cytoreduction and intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma: operative morbidity and mortality in phase I and II trials. Eur J Surg Oncol. 2010;36(10):997–1003.
Taioli E, Wolf AS, Camacho-Rivera M, et al. Determinants of survival in malignant pleural mesothelioma: a surveillance, epidemiology, and end results (SEER) study of 14,228 patients. PLoS ONE. 2015;10(12):e0145039.
Friedberg JS. Radical pleurectomy and photodynamic therapy for malignant pleural mesothelioma. Ann Cardiothorac Surg. 2012;1(4):472–80.
Karpathiou G, Argiana E, Koutsopoulos A, Froudarakis ME. Response of a patient with pleural and peritoneal mesothelioma after second-line chemotherapy with lipoplatin and gemcitabine. Oncology. 2007;73(5–6):426–9.
Ito S, Isowa N, Li M, Hasegawa S, Wada H. Parasternal lymph node metastasis of malignant peritoneal mesothelioma: report of a case. Surg Today. 2005;35(9):782–4.
Miliauskas S, Zemaitis M, Pranys D. Malignant pleural and peritoneal mesothelioma: incidental diagnosis and excellent treatment results. J Thorac Oncol. 2009;4(3):435–6.
Yan TD, Deraco M, Baratti D, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009;27(36):6237–42.
Bovolato P, Casadio C, Bille A, et al. Does surgery improve survival of patients with malignant pleural mesothelioma?: A multicenter retrospective analysis of 1365 consecutive patients. J Thorac Oncol. 2014;9(3):390–6.
Heller DR, Chiuzan C, Taub RN, et al. Recurrence of optimally treated malignant peritoneal mesothelioma with cytoreduction and heated intraperitoneal chemotherapy. Ann Surg Oncol. 2017;24(13):3818–24.
Saddoughi SA, Abdelsattar ZM, Blackmon SH. National trends in the epidemiology of malignant pleural mesothelioma: a national cancer data base study. Ann Thorac Surg. 2018;105(2):432–7.
Scherpereel A, Astoul P, Baas P, et al. Guidelines of the European respiratory society and the European society of thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J. 2010;35(3):479–95.
Sugarbaker PH, Chang D. Long-term regional chemotherapy for patients with epithelial malignant peritoneal mesothelioma results in improved survival. Eur J Surg Oncol. 2017;43(7):1228–35.
Wong J, Koch AL, Deneve JL, Fulp W, Tanvetyanon T, Dessureault S. Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience. Ann Surg Oncol. 2014;21(5):1480–6.
Huang Y, Alzahrani NA, Liauw W, Morris DL. Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma. Eur J Surg Oncol. 2015;41(10):1373–8.
Helm JH, Miura JT, Glenn JA, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: a systematic review and meta-analysis. Ann Surg Oncol. 2015;22(5):1686–93.
van Meerbeeck JP, Scherpereel A, Surmont VF, Baas P. Malignant pleural mesothelioma: the standard of care and challenges for future management. Crit Rev Oncol Hematol. 2011;78(2):92–111.
Lang-Lazdunski L, Bille A, Lal R, et al. Pleurectomy/decortication is superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma. J Thorac Oncol. 2012;7(4):737–43.
Wald O, Groth SS, Burt BM, Sugarbaker DJ. Role of thoracoscopy, mediastinoscopy and laparoscopy in the diagnosis and staging of malignant pleural mesothelioma. J Vis Surg. 2016;2:129.
Rice DC, Erasmus JJ, Stevens CW, et al. Extended surgical staging for potentially resectable malignant pleural mesothelioma. Ann Thorac Surg. 2005;80(6):1988–92; discussion 1992–1983.
Zhang S, Zhang Q, Sun Q, et al. Genome evolution analysis of recurrent testicular malignant mesothelioma by whole-genome sequencing. Cell Physiol Biochem. 2018;45(1):163–74.
The authors appreciate the evaluation of the SEER database by Dr. Kiran Turaga and Dr. Scott Sherman for cases of dual-cavity disease.
There are no conflicts of interest.
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Letica-Kriegel, A.S., Leinwand, J.C., Sonett, J.R. et al. 50 Patients with Malignant Mesothelioma of Both the Pleura and Peritoneum: A Single-Institution Experience. Ann Surg Oncol 27, 205–213 (2020). https://doi.org/10.1245/s10434-019-07409-5