Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Outcomes From a Tertiary Cancer Care Center in India

Our plain-English summary of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Outcomes From a Tertiary Cancer Care Center in India, by M. Ray, B. Pathak, R. Venugopal, et al (Curēus, 2024).

The study

• Authors: M. Ray, B. Pathak, R. Venugopal, S. Sonvane
• Journal: Curēus
• Published: 2024;16(11):e73658
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant peritoneal mesothelioma (MPM) is a rare and aggressive form of cancer arising from the peritoneum. The prognosis for MPM has historically been poor, and treatment options are limited. This study evaluated the impact of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) as a treatment modality for MPM.

Materials And Methods: This retrospective analysis included 15 patients diagnosed with MPM between 2012 and 2023 at a tertiary referral cancer care center in North India. Patients underwent CRS followed by HIPEC. The study assessed outcomes based on overall survival (OS) and postoperative morbidity rates.

Results: Demographic analysis revealed a female preponderance (n = 9, 60%) and a majority of younger patients, 80% (n = 12) of whom were younger than the age of 50. The mean peritoneal cancer index (PCI) was 14.0, with 60% (n = 9) of patients having a PCI above the mean. The completeness of cytoreduction (CC) varied, with 40% (n = 6) achieving CC0, 33.33% (n = 5) CC1, and 26.67% (n = 4) CC2. Adjuvant chemotherapy was administered to 60% (n = 9) of the patients. The median follow-up period was 25 months, revealing an overall median survival of 27.0 months, with one- and three-year survival rates of 86.7% and 33.3%, respectively.

Conclusion: CRS combined with HIPEC is a viable and effective treatment option for patients with MPM and offers improved survival rates and an acceptable safety profile. These findings support the integration of this treatment modality into the management plan for select patients with MPM, although optimal management is still evolving.

Copyright © 2024, Ray et al.

In plain English

This retrospective study covered 15 patients with malignant peritoneal mesothelioma, a cancer of the lining of the abdomen, treated at the All India Institute of Medical Sciences in New Delhi between 2012 and 2023. All had cytoreductive surgery, aiming to remove all visible tumor, followed by heated chemotherapy (cisplatin and pemetrexed) circulated through the abdomen, known as HIPEC. Nine patients were women, the mean age was 40.5 years, and none of the 15 had a history of asbestos exposure. Complete removal of visible tumor was achieved in 6 of 15 patients. After a median follow-up of 25 months, estimated median survival was 27.0 months. Estimated survival was 86.7% at one year (reported interval 71.1% to 100.0%) and 33.3% at three years (16.3% to 68.2%). Of the factors tested, only tumor cell type was statistically linked to survival. One patient died of a heart attack after surgery, and seven had no significant complications. The authors concluded that in specialized centers this treatment has been observed to improve survival, although optimal management is still evolving. They noted the study was retrospective, from one center, and small.

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: Retrospective analysis of a prospectively maintained database (single-center observational case series, no comparison group)
• Who was studied: 15 patients with histologically diagnosed malignant peritoneal mesothelioma treated in the Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, 2012 to 2023. 9 were female (60%), and the mean age was 40.5 years (SD 14.0).
• Exposure: The study examined a treatment, not an asbestos exposure: cytoreductive surgery followed by 90 minutes of HIPEC with cisplatin (50 mg/m2) and pemetrexed (500 mg/m2). None of the 15 patients had a history of asbestos exposure.
• Main results:
  • All 15 patients had no history of asbestos exposure.
  • Complete cytoreduction (CC0) was achieved in 6 patients (40.00%). 5 (33.33%) had CC1 and 4 (26.67%) had CC2.
  • Median follow-up from surgery was 25 months (range 0.2-112 months).
  • In the 15 patients, overall median survival by the Kaplan-Meier method was 27.0 months.
  • In the 15 patients, one-year survival was 86.7% (71.1%-100.0%) and three-year survival was 33.3% (16.3%-68.2%).
  • On univariate analysis, only histological subtype was a significant predictor of overall survival (p = 0.01). PCI (p = 0.91) and completeness of cytoreduction (p = 0.18) were not significant. Epithelioid was the most common subtype, at 10 of 15 (66.67%).
  • Seven patients had no significant postoperative complications. Four (26.67%) had Grade I complications. One patient (6.67%) died of a myocardial infarction postoperatively.
  • Median ICU stay was one day (range one to five). Median hospital stay was eight days (range five to 17).
• The authors' conclusion: The authors concluded that, in specialized centers, extensive surgery with HIPEC has been observed to improve survival, as shown by their institution's experience, although optimal management is still evolving. They also stated that the benefit of chemotherapy given before or after surgery is uncertain.
• Limitations the authors state:
  • The study was retrospective, used data from a single center, had a limited sample size, and lacked Ki67 reporting in the histopathology.
  • The authors suggested that the small sample size may explain why PCI and completeness of cytoreduction were not significant predictors of survival.

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Peritoneal Mesothelioma, Peritoneum, Prognosis, Overall Survival, Peritoneal Cancer Index (PCI), Chemotherapy.

Related studies

• Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center — C.G. Trujillo, C. Domínguez, et al. (2018)
• Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy — K.I. Votanopoulos, C. Ihemelandu, et al. (2012)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• 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)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)
• Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry — K.I. Votanopoulos, P. Sugarbaker, et al. (2018)

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