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Cytoreductive Surgery and Intraperitoneal Chemotherapy for Treatment of Malignant Peritoneal Mesothelioma

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Caring for Patients with Mesothelioma: Principles and Guidelines

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Abstract

The standard of care for malignant peritoneal mesothelioma (MPM) has evolved over the last 30 years as a result of persistent clinical research. The median survival in the past was estimated at 1 year. Most recent reports show median survival not reached and a 5-year survival estimated at 70%. The treatments that may be offered to the MPM patient are cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and normothermic intraperitoneal chemotherapy long-term (NIPEC-LT). The CRS may require a series of peritonectomy procedures and bowel resections and surgery may require many hours in the operating room. The surgery is to remove as much disease as possible. The greatest benefit occurs when all visible evidence of MPM is resected. The second treatment is HIPEC. This is heated cisplatin or mitomycin C chemotherapy used in the operating room after the completion of the CRS. The chemotherapy solution is maintained at 42°C and continues for 90 minutes. After the patient recovers from CRS plus HIPEC, adjuvant chemotherapy should be recommended. To date, the greatest benefit may occur if the cisplatin is used intravenously (IV) and pemetrexed is used intraperitoneally (IP). This NIPEC-LT is continued for 6 months. Follow-up continues for 10 years and involves CT scans every 6 months for 3 years and then yearly for the remainder of the decade.

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Authors and Affiliations

  1. Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, Washington, DC, USA

    Paul H. Sugarbaker

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  1. Paul H. Sugarbaker
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Correspondence to Paul H. Sugarbaker .

Editor information

Editors and Affiliations

  1. Mesothelioma Applied Research Foundation, Alexandria, VA, USA

    Mary Hesdorffer

  2. City University of New York, Graduate Center, New York, NY, USA

    Gleneara E. Bates-Pappas

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Sugarbaker, P.H. (2019). Cytoreductive Surgery and Intraperitoneal Chemotherapy for Treatment of Malignant Peritoneal Mesothelioma. In: Hesdorffer, M., Bates-Pappas, G. (eds) Caring for Patients with Mesothelioma: Principles and Guidelines. Springer, Cham. https://doi.org/10.1007/978-3-319-96244-3_3

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  • DOI: https://doi.org/10.1007/978-3-319-96244-3_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96243-6

  • Online ISBN: 978-3-319-96244-3

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