Radiological predictors of complete cytoreduction in 59 patients with peritoneal mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a UK referral centre

Malignant peritoneal mesothelioma (MPM) is a very rare malignancy of the peritoneum and has a poor prognosis. Of all mesotheliomas, pleural mesothelioma is more common than MPM. In comparison to pleural mesothelioma, the link with asbestos exposure is weaker (33-50% vs. >80%), but it is still the bestdefined risk factor. MPM spreads predominantly expansive rather than infiltrative and symptoms are related to tumor spread within the abdominal cavity. Often, MPM is encountered incidentally by diagnostic imaging or by surgery. Computed tomography scan is widely accepted as a first line modality in diagnostic imaging. In diagnostic histopathology, MPM presents some challenges. Firstly, adequate clinical information is of utmost importance to consider the possibility of the diagnosis of MPM. Furthermore, a few morphological subtypes and variants exist. The most sensitive immunohistochemical markers are calretinin (100%), WT1 (94%) and CK5/6 (89%). The malignant character of immunohistochemically demonstrated mesothelial cells is not always obvious. This paradigm somewhat changed with the advent of immunohistochemical demonstration of BAP1 (BRCA-1 associated protein 1). Loss of BAP1 expression supports a diagnosis of malignancy. The gold standard in treatment remains cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Targetable molecular pathways in MPM are being identified. An exciting finding was the demonstration of ALK rearrangements in a small subset of patients with MPM and it is hoped for that at least this small subgroup of patients could benefit from treatment with ALK inhibitors. First-generation tyrosine kinase inhibitors against epidermal growth factor receptor (EGFR) did not show any significant activity in MPM. In contrast, nintedanib, an angiokinase inhibitor, improved progressionfree survival and bevacizumab, a humanized anti-VEGF antibody increased overall survival in patients with MPM, when administered in combination with cisplatin and pemetrexed. Ongoing immunotherapy trials will offer a possible new treatment.

show abstract

“…A scoring system for small bowel and mesenteric involvement has been developed based on assessment by contrast enhanced CT (9).…”

Section: Diagnostic Imagingmentioning

confidence: 99%

Malignant peritoneal mesothelioma: a review

Broeckx

Pauwels

2018

Transl. Lung Cancer Res

View full text Add to dashboard Cite

show abstract

“…Computed tomography (CT) of the chest, abdomen, and pelvis is the first-line imaging modality in the diagnostic workup of MPeM. 5 Ascites, peritoneal thickening, omental disease, small bowel involvement and solid and cystic masses are typical of MPeM on CT. 6 – 8 However, the sensitivity and specificity of CT in the diagnosis of MPeP is not described in the literature. The role of PET-CT in the diagnosis and workup of MPeM is likewise unclear.…”

Section: Introductionmentioning

confidence: 99%

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

Salo

Lantto

Robinson

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Malignant peritoneal mesothelioma (MpeM) is a rare cancer of the mesothelial cells of the peritoneum. Computed tomography (CT) is considered the standard for first-line imaging of MPeM, diagnosis and risk stratification remains challenging. Peritoneal cancer index (PCI), as assessed by CT, is utilized in the prognostic assessment of other malignant intra-abdominal conditions; however, there is limited data concerning the utility of PCI in the diagnosis and workup of MPeM. We studied a retrospective cohort of all patients diagnosed with MPeM from 2000 to 2012 in Finland. CT and magnetic resonance imaging (MRI) were reviewed and scored by an experienced and blinded, board-certified abdominal radiologist. Additional clinical data and outcomes were obtained from Finnish Cancer Registry (FCR), the Workers' Compensations Center (WCC), and Statistics Finland (SF). Abdominal CT or MRI was available for 53 of 90 patients. The median radiographic PCI was 25. PCI score was correlated with overall survival (p = 0.004, Exp(B) = 1.064, 95% CI 1.020-1.110). PCI score ≥ 30 was associated with worse survival (p = 0.002), while PCI ≤ 19 was associated with improved overall survival (p = 0.001). Our study indicates that radiological pci is prognostic in MpeM and should be assessed during radiographic workup and integrated into clinical decision-making. Malignant peritoneal mesothelioma (MPeM) is a rare cancer of the mesothelial cells of peritoneum, representing 7-30% of all mesothelioma diagnoses. 1 Signs and symptoms of MPeM are non-specific and include abdominal pain, abdominal distension, and weight loss. Given the rarity of the diagnosis and the non-specific presentation, diagnosis is often delayed. 2,3 Previous reports have indicated median time of 4-6 months between initial presentation and diagnosis. 4 Computed tomography (CT) of the chest, abdomen, and pelvis is the first-line imaging modality in the diagnostic workup of MPeM. 5 Ascites, peritoneal thickening, omental disease, small bowel involvement and solid and cystic masses are typical of MPeM on CT. 6-8 However, the sensitivity and specificity of CT in the diagnosis of MPeP is not described in the literature. The role of PET-CT in the diagnosis and workup of MPeM is likewise unclear. 9 Peritoneal mesothelioma is not well suited to traditional classification schemes like the TNM staging due to the rarity of distant metastases and the difficulty in discerning the full extent primary tumor versus local/regional spread. Several staging systems for MPeM have been proposed but to date have not been widely adopted. 10 Peritoneal cancer index (PCI) is a measure of disease spread developed for peritoneal carcinomatosis

show abstract

“…From those two complimentary modalities though, the key determinant of the long-term outcome is undoubtedly the successful macroscopic surgical tumor removal and not the administration of intraperitoneal chemotherapy, which only has the auxiliary role of eliminating intraperitoneally floating tumor cells or deposits of millimetric extent. Published data from peritoneal surface malignancies centers indicate that extensive involvement of small bowel serosa, along with presence of high-volume tumor deposits in the upper abdomen, has been associated with greater likelihood of inability to achieve a complete cytoreduction [10]. In our case, the foci of tumor were the right iliac fossa and its ipsilateral parietal peritoneal surface, along with the pelvic peritoneum and on the greater omentum.…”

Section: Discussionmentioning

confidence: 56%

Benign Multicystic Peritoneal Mesothelioma Presenting as Appendiceal Abscess: A Diagnostic and Therapeutic Challenge

et al. 2020

View full text Add to dashboard Cite

Primary peritoneal tumors are rarely encountered and their management is usually challenging for the clinicians. Especially when the patients with advanced peritoneal malignancy present as surgical emergencies, usually with symptoms of obstruction, perforation or gross space-occupying lesions, the on-call surgical team has to weigh the pros and cons of urgent versus delayed treatment and plans a safe and simultaneously oncologically beneficial therapeutic approach. Herein, we present a case of a Caucasian man who was referred as suspected complicated appendicitis by his primary care physician, with the final diagnosis being benign multicystic mesothelioma. We describe the challenges of the clinical decision making for the emergency general surgeon and relevant diagnostic and therapeutic pitfalls, which can be potentially minimized by early liaison with tertiary units specializing in the treatment of disseminated peritoneal malignancy.

show abstract

Radiological predictors of complete cytoreduction in 59 patients with peritoneal mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a UK referral centre

Cited by 11 publications

References 26 publications

Malignant peritoneal mesothelioma: a review

Malignant peritoneal mesothelioma: a review

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

Benign Multicystic Peritoneal Mesothelioma Presenting as Appendiceal Abscess: A Diagnostic and Therapeutic Challenge

Contact Info

Product

Resources

About