Long-term survival in peritoneal mesothelioma treated with 24 consecutive PIPACs

Our plain-English summary of Long-term survival in peritoneal mesothelioma treated with 24 consecutive PIPACs, by M. Mehdorn, B. Jansen-Winkeln, P. Rhode, et al (Pleura and Peritoneum, 2025).

The study

• Authors: M. Mehdorn, B. Jansen-Winkeln, P. Rhode, S. Niebisch, Y. Moulla, T. Schönherr, P.S. Plum, F. Lordick, R. Thieme, G. Stocker, M. von Laffert, I. Gockel, S. Stelzner
• Journal: Pleura and Peritoneum
• Published: 2025;10(3):111-117
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Malignant peritoneal mesothelioma (MPM) is a rare disease with unspecific abdominal symptoms which is therefore often diagnosed at an advanced stage. Curative therapy is delivered by radical surgery, whereas palliative therapy consists of systemic chemotherapy. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a laparoscopically applied chemotherapy which was invented to administer high doses of chemotherapy intraperitoneally in palliative cases of peritoneal malignancies.

Methods: The case of a male patient who received PIPAC treatment as individualized approach for unresectable malignant peritoneal mesothelioma is reported.

Results: The patient began treatment with PIPAC procedures in 2017 for MPM that was unresectable because of extensive disease on the small bowel and refused systemic chemotherapy as the usual standard of care. We initiated PIPAC with doxorubicin and cisplatin and could reach stable disease within one year of treatment so that the therapy was discontinued for 2.5 years. Due to progressive disease, PIPAC was continued resulting in stable disease for 2 years. In total, the patient received 24 PIPAC procedures with no major surgical or toxic side effects over seven years timespan.

Conclusions: We report the case of a patient with MPM who could reach long-term survival of seven years due to a total of 24 PIPAC procedures.

© 2025 the author(s), published by De Gruyter, Berlin/Boston.

In plain English

This was a case report of one 68-year-old man diagnosed with malignant peritoneal mesothelioma in 2017. Tumor-removal (cytoreductive) surgery was ruled out because the tumor extensively involved the small intestine, and he refused the recommended systemic chemotherapy. The article does not report whether he had been exposed to asbestos. He instead received pressurized intraperitoneal aerosol chemotherapy (PIPAC), a keyhole procedure spraying doxorubicin and cisplatin into the abdomen, with no other chemotherapy. After about a year, biopsies showed tumor regression and the disease was stable, so treatment paused for 2.5 years. When abdominal fluid (ascites) increased, PIPAC restarted and kept the fluid stable for two years, though it later reached 15 L. In total he had 24 procedures. PIPAC was stopped when ascites progressed rapidly and his performance status declined. No major surgical complications or chemotherapy toxicity occurred. He survived more than seven years after diagnosis. The authors concluded that PIPAC alone is a viable option for patients suited to repeated laparoscopic surgeries who are not eligible for, or refuse, systemic chemotherapy. They noted that a single case report has inherent limitations.

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 (single patient)
• Who was studied: One 68-year-old man with no relevant comorbidities (ECOG performance status 0), diagnosed in 2017 with papillary, partially epitheloid and infiltrative malignant peritoneal mesothelioma (peritoneal carcinomatosis index 18). The tumor was unresectable because of extensive small-intestine involvement, which made him ineligible for cytoreductive surgery (CRS). He was enrolled in the authors' institutional PIPAC database (authors based at University Hospital of Leipzig, Germany).
• Exposure: Treatment studied: PIPAC with doxorubicin (1.5 mg/m2) and cisplatin (7.5 mg/m2), without systemic chemotherapy. The article does not report the patient's asbestos exposure history. Asbestos is mentioned only in the background, as the primary environmental risk factor for mesothelioma.
• Main results:
  • During initial treatment, peritoneal biopsies showed histological regression (PRGS 2), and the disease was stable.
  • After initial treatment, the patient went 2.5 years without PIPAC and without needing fluid drainage.
  • When PIPAC restarted, biopsies showed increased tumor (PRGS 3). With 12-week intervals, regression was seen again (PRGS 2).
  • After restart, ascites remained stable for two years. Two and a half years after restart, ascites increased to 15 L and needed drainage.
  • The patient had 24 PIPAC procedures in total. PIPAC was stopped because ascites progressed rapidly and his performance status declined.
  • No major surgical complications or chemotoxicity occurred. In later stages the 12 mm trocar site healed slowly, and the peritoneum became fibrotic.
  • The patient rated his overall quality of life 6 out of 7.
  • The patient survived more than seven years after diagnosis and received no concomitant chemotherapy.
• The authors' conclusion: The authors concluded that PIPAC alone is a viable treatment option in malignant mesothelioma for patients who are suitable for an individualized approach involving repeated laparoscopic surgeries and who are either not eligible for or refuse systemic chemotherapy.
• Limitations the authors state:
  • The authors note that this is only a case report with inherent limitations, and that large, well-designed studies are needed.
  • The authors note that patient-specific factors played a crucial role in the outcome: his age, the histological subtype, and the absence of extra-abdominal metastases.
  • Quality-of-life questionnaires were not completed for the last four PIPAC procedures.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Palliative Care, Chemotherapy, Unresectable, Doxorubicin, Cisplatin.

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