Bidirectional chemotherapy allowing surgery and HIPEC for malignant peritoneal mesothelioma

Our plain-English summary of Bidirectional chemotherapy allowing surgery and HIPEC for malignant peritoneal mesothelioma, by B. Noiret, C. Eveno (Pleura and Peritoneum, 2019).

The study

• Authors: B. Noiret, C. Eveno
• Journal: Pleura and Peritoneum
• Published: 2019;4(2):20190011
• Read it: PubMed · Publisher · Free full text

Abstract

Background: This case report aims to describe the impact of the bidirectional chemotherapy (BDC) on resecability for initially unresectable malignant peritoneal mesothelioma (MPM).

Methods: We report a case of 55-year-old male with the diagnosis of initially unresecable MPM. The BDC combined intravenous (IV) chemotherapy (Cisplatin-Pemetrexed) and intra peritoneal (IP) chemotherapy (Cisplatin). The response to chemotherapy was assessed by CT - scan and laparoscopy.

Results: Initial evaluation classed the disease as unresecable with PCI at 39. At the reevaluation, CT - scan and laparoscopy showed a macroscopic response, allowing surgery consisting of cytoreductive surgery and hyperthermic intra peritoneal chemotherapy (Doxorubicin and Cisplatin).

Conclusions: BDC (IV and IP) has promising results and allows to undergo surgery for selected patients with borderline or initially unresectable MPM.

In plain English

This short case report, a 'Clinical Images' article by authors at a university hospital in Lille, France, described one 55-year-old man with malignant peritoneal mesothelioma. The article did not mention asbestos or any other exposure. At diagnosis, CT scan and laparoscopy showed disease judged unresectable, with a PCI score of 39. There were deposits on the omentum, small bowel and abdominal lining, and fluid in the abdomen. He received three cycles of intravenous cisplatin and pemetrexed. These were followed by three cycles combining intravenous pemetrexed with cisplatin given directly into the abdomen, which the authors call bidirectional chemotherapy. At reevaluation the PCI score was still 39, but the authors described a visible response, with thinner disease. This allowed complete cytoreductive surgery with heated chemotherapy (doxorubicin and cisplatin) given into the abdomen (HIPEC). The article did not report how the patient fared after surgery. The authors concluded that this combined treatment has promising results and allows surgery for selected patients with borderline or initially unresectable disease. A single case does not show how often this happens.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (published as a 'Clinical Images' article)
• Who was studied: one 55-year-old man with malignant peritoneal mesothelioma; authors based at Claude Huriez University Hospital, CHU Lille, France; dates of treatment not given
• Exposure: No asbestos or other exposure history is reported. The article concerns treatment: intravenous cisplatin-pemetrexed, then intravenous pemetrexed with intraperitoneal cisplatin (bidirectional chemotherapy), followed by cytoreductive surgery and HIPEC
• Main results:
  • At diagnosis, CT scan and laparoscopy showed unresectable disease with a PCI of 39 in this patient
  • Treatment was three cycles of intravenous cisplatin-pemetrexed, then three cycles of intravenous pemetrexed with intraperitoneal cisplatin
  • At reevaluation the PCI was unchanged at 39, but there was a macroscopic (visible) response
  • The disease was thinner, allowing complete cytoreductive surgery with doxorubicin/cisplatin-based HIPEC
• The authors' conclusion: The authors concluded that bidirectional (intravenous and intraperitoneal) chemotherapy has promising results and allows selected patients with borderline or initially unresectable malignant peritoneal mesothelioma to undergo surgery

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, HIPEC, Peritoneal Mesothelioma, Unresectable, Cisplatin, Pemetrexed (Alimta), Cytoreductive Surgery, Doxorubicin.

Related studies

• Conversion to Complete Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma After Bidirectional Chemotherapy — F. Le Roy, M. Gelli, et al. (2017)
• A 51-Year-Old Woman with Advanced Peritoneal Mesothelioma and Stage 3b Chronic Kidney Disease Treated with Cytoreductive Surgery and Bidirectional Intraperitoneal Cisplatin and Ifosfamide Chemotherapy: A Case Report — M. Alaswad, F. ElKordy, et al. (2023)
• Randomized trial of intravenous versus bidirectional chemotherapy after cytoreductive surgery for malignant peritoneal mesothelioma — P.H. Sugarbaker (2023)
• The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — S. Kusamura, P.A. Torres Mesa, et al. (2016)
• Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — D. Baratti, M. Vaira, et al. (2010)
• National Guidelines for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Peritoneal Malignancies: A Worldwide Systematic Review and Recommendations of Strength Analysis — M. Tonello, C. Cenzi, et al. (2025)

Browse more research in Pleura and Peritoneum, or return to medical research.