Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma

Our plain-English summary of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma, by A.U. Blackham, E.A. Levine (European Journal of Clinical & Medical Oncology, 2012).

The study

• Authors: A.U. Blackham, E.A. Levine
• Journal: European Journal of Clinical & Medical Oncology
• Published: 2012;4(2):25-32
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare and aggressive neoplasm that is largely resistant to traditional anti-cancer therapies. For years it has been considered a terminal condition and once diagnosed, patients generally survived less than a year despite aggressive treatment. Although rare, the worldwide incidence of MPM continues to rise, in part due to its association with asbestos exposure. Patients usually present with non-specific symptoms of abdominal distension and pain making the diagnosis challenging. In recent years, aggressive cytoreductive surgery with the administration of hyperthermic intraperitoneal chemotherapy (HIPEC) has improved survival in patients with MPM treated at multiple centers worldwide. This review article briefly highlights the presentation, diagnosis, and natural history of MPM. We then explore the available treatment options with primary focus on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

In plain English

This review article looked at published research on treating malignant peritoneal mesothelioma, a cancer of the abdominal lining, with cytoreductive surgery combined with heated chemotherapy delivered into the abdomen (HIPEC). The surgery aims to remove as much visible tumor as possible. The article reported no new patient data of its own. Studies it cited put median survival before modern treatment at 6 to 8.2 months. Among the series reviewed, the authors' own earlier study of 38 patients reported median survival of 40.8 months, with 3- and 5-year survival of 56% and 17%. A multi-institutional registry of 401 patients at eight institutions reported median survival of 53 months, 3- and 5-year survival of 60% and 47%, and complications in 46% of patients. On asbestos, the review noted that cited studies found a much weaker link with peritoneal than with pleural mesothelioma, especially in women. The authors noted that the evidence comes mainly from small single-institution studies with selection bias and differing regimens, and that there is no "level 1 evidence" comparing the treatment with traditional therapies. The authors concluded that this treatment should be considered standard of care.

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: Narrative review of published studies (no new patient data)
• Who was studied: Published series of patients with malignant peritoneal mesothelioma treated with cytoreductive surgery and HIPEC, mostly single-institution studies plus one multi-institutional registry and one meta-analysis
• Exposure: Not an asbestos exposure study. The subject is a treatment: aggressive cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Asbestos is discussed only as background.
• Main results:
  • Cited older studies: median survival for peritoneal mesothelioma patients before modern treatment options was 6 to 8.2 months
  • The authors' own earlier published series (38 patients treated with cytoreductive surgery and HIPEC over 15 years): median overall survival 40.8 months; 3-year survival 56% and 5-year survival 17%
  • In that same earlier series, patients perfused with cisplatin had a trend toward better overall survival than those perfused with mitomycin (40.8 vs 10.8 months), which was not statistically significant. The authors reported a significant difference in 3-year survival (80% vs 42%).
  • Multi-institutional registry (Yan 2009; 401 patients at eight institutions): overall median survival 53 months; 3-year survival 60% and 5-year survival 47%
  • In the same registry, 188 patients (46%) had a perioperative complication
  • Across the major studies reviewed, completeness of cytoreduction was associated with improved survival
  • Cited studies found the association between asbestos exposure and peritoneal mesothelioma much weaker than for pleural mesothelioma, especially in females. In those studies, 29-58% of males and 2-23% of females with peritoneal mesothelioma reported known asbestos exposure.
• The authors' conclusion: The authors concluded that, based on the available evidence, cytoreductive surgery plus HIPEC should be considered standard of care for patients with malignant peritoneal mesothelioma
• Limitations the authors state:
  • The available studies include relatively small numbers of patients, and treatment regimens differ between institutions
  • Selection bias results from relying on phase I/II single-institution studies
  • Different HIPEC regimens at each institution make direct comparisons between studies difficult

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Peritoneal Mesothelioma, Neoplasm, Asbestos Exposure.

Related studies

• Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for malignant peritoneal mesothelioma: mitomycin versus cisplatin — A.U. Blackham, P. Shen, et al. (2010)
• Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy — K.I. Votanopoulos, C. Ihemelandu, et al. (2012)
• 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)
• Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma: patient selection and special considerations — L.M. Enomoto, P. Shen, et al. (2019)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: a systematic review and meta-analysis — J.H. Helm, J.T. Miura, et al. (2015)
• Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — G. Glockzin, H.J. Schlitt, et al. (2009)

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