<p>Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma: patient selection and special considerations</p>

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare, aggressive malignancy that typically presents with vague symptoms, ascites, and/or diffuse peritoneal studding. Despite findings of advanced disease within the peritoneal cavity, spread beyond the abdomen is uncommon. Although advances in systemic chemotherapy have been made, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remain the mainstay of treatment. Median overall survival of approximately 50 months with CRS/HIPEC has been demonstrated, with age, gender, histologic subtype, peritoneal carcinomatosis index, comorbidities, nodal and extra-abdominal metastases, and completeness of cytoreduction all playing a role in prognosis. In patients with refractory malignant ascites and unresectable disease, complete resolution of ascites and improvement in quality of life have been demonstrated with palliative HIPEC. In appropriately selected patients, CRS/HIPEC plays a critical role in the treatment and palliation of MPM.

Prognostic role of radiological peritoneal cancer index in malignant peritoneal mesothelioma: national cohort study

“…Lymph node involvement (5-10%) and extra-abdominal metastases (3-5%) are considered relatively rare complications associated with advanced late stage disease. 9,21 However, in this study cohort 26.4% of patients were observed to have evidence of lymph node involvement and/or extra-abdominal metastases. As we were unable to confirm lymph node spread pathologically in most cases, it is possible that this result is biased by our reliance on radiographic staging alone.…”

“…Ascites is a common radiographic finding and was observed in 79.2% of the patients. 21 While the median survival of patients with ascites was 7 months—compared to 39-months in patients without ascites—this result was not significant. Our study was likely underpowered to detect such a difference given the relative small proportion of patients with absent ascites and size of the study cohort.…”

“…Ascites is a common radiographic finding and was observed in 79.2% of the patients. 21 While the median survival of patients with ascites was 7 months-compared to 39-months in patients without ascites-this result was not 13 Novel nomogram for 3-and 5-year overall survival 2014 Magge et al 12 The Dutch simplified peritoneal cancer index (SPCI)…”

Modeling of Chemoperfusion vs. Intravenous Administration of Cisplatin in Wistar Rats: Adsorption and Tissue Distribution

“…The clinical application of HIPEC for almost 30 years has proven its efficacy against certain tumor types (pseudomyxoma peritonei and malignant peritoneal mesothelioma) [ 18 , 19 ]. Most convincing evidence in favor of HIPEC regimes with cisplatin (100 mg/m 2 ) for locally advanced ovarian cancer, was recently provided in a randomized controlled trial by van Driel et al The authors achieved significant benefit in median overall survival for HIPEC compared to surgery alone (45.7 months vs. 33.9 months) [ 20 ].…”

“Omental Cake” in a Patient With Asbestosis Leading to the Diagnosis of Malignant Peritoneal Mesothelioma

“…The selection of the best therapeutic management should be done by a multidisciplinary team specialized in this type of neoplasm, with the current therapeutic options being both cytoreductive surgery with intraperitoneal hyperthermic chemotherapy or systemic chemotherapy [1][2][3][4]9]. The patients who benefit from this first, more aggressive therapy are those with good performance status (defined as Eastern Cooperative Oncology Group score 0 or 1), disease distribution favorable for complete or near-complete cytoreductive surgery (extension and depth of the tumor disease does not affect beyond the mesothelial surface), epithelioid histology, female sex (female patients survive longer than male patients), age <60 years, and absence of pretreatment thrombocytosis [1][2][3][4][9][10][11]. However, for those patients who do not meet these characteristics or whose condition is not operable, systemic chemotherapy (cisplatin and pemetrexed) must be considered, although the disease is usually refractory to the usual regimens [1][2][3][4]9].…”