Malignant peritoneal mesothelioma

Our plain-English summary of Malignant peritoneal mesothelioma, by S. Munkholm-Larsen, C.Q. Cao, T.D. Yan (World Journal of Gastrointestinal Surgery, 2009).

The study

• Authors: S. Munkholm-Larsen, C.Q. Cao, T.D. Yan
• Journal: World Journal of Gastrointestinal Surgery
• Published: 2009;1(1):38-48
• Cited by: 47 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a highly aggressive neoplasm. The incidence of malignant mesothelioma is increasing worldwide. Diffuse malignant peritoneal mesothelioma (DMPM) represents one-fourth of all mesotheliomas. Association of asbestos exposure with DMPM has been observed, especially in males. The great majority of patients present with abdominal pain and distension, caused by accumulation of tumors and ascitic fluid. In the past, DMPM was considered a pre-terminal condition; therefore attracted little attention. Patients invariably died from their disease within a year. Recently, several prospective trials have demonstrated a median survival of 40 to 90 mo and 5-year survival of 30% to 60% after combined treatment using cytoreductive surgery and perioperative intraperitoneal chemotherapy. This remarkable improvement in survival has prompted new search into the medical science related to DMPM, a disease previously ignored as uninteresting. This review article focuses on the key advances in the epidemiology, diagnosis, staging, treatments and prognosis of DMPM that have occurred in the past decade.

In plain English

This article reviewed published research on diffuse malignant peritoneal mesothelioma (DMPM), a cancer of the abdominal lining. The authors did not study new patients. They covered epidemiology, symptoms, diagnosis, staging, treatment and outlook. Citing other studies, they wrote that some studies with enough cases showed a strong association between estimated work exposure to asbestos and DMPM, especially in men. They also reported an estimate of about 250 new US cases a year. They described median survival under older treatments before 2000 as less than one year. The review then turned to cited studies of tumor-removing surgery combined with chemotherapy given into the abdomen. One US series of 49 patients reported median survival of 92 months; a series of 100 patients reported 52 months. In cited studies, patients with lymph node spread, or with larger tumor-cell nuclei, did worse. The authors concluded that the disease can now be treated with curative intent at referral centers. They also noted high complication rates, no direct comparisons with older treatments, and a lack of high-level evidence, and proposed a shared patient registry.

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 literature (no new patients studied)
• Who was studied: Published studies of patients with diffuse malignant peritoneal mesothelioma (DMPM), focusing on advances over roughly the preceding decade
• Exposure: Not studied directly. The review summarized other studies linking estimated occupational asbestos exposure to DMPM, especially in males; no fiber types were named. It also noted reports of DMPM after radiation therapy, mica exposure, recurrent peritonitis and thorium dioxide.
• Main results:
  • A cited analysis of the US Surveillance, Epidemiology, and End Results program estimated about 250 new DMPM cases per year in the United States
  • The authors described median survival under traditional treatments (systemic chemotherapy, palliative surgery) before 2000 as less than one year. The accompanying table of older series lists medians of 9 to 15 months, some for combined pleural and peritoneal cases.
  • In a cited non-randomized study, 66 DMPM patients treated with systemic pemetrexed and cisplatin had a median survival of 13 months and 1-year survival of 66%. This compared with 9 months and 0% for 32 patients given pemetrexed alone. The authors said definitive conclusions were difficult to draw from the limited data.
  • In a cited US National Cancer Institute phase II study, 49 DMPM patients treated with cytoreductive surgery and intraperitoneal hyperthermic chemotherapy had a median survival of 92 months and 5-year survival of 59%
  • In a cited Washington Cancer Institute series of 100 DMPM patients given the combined treatment, overall median survival was 52 months, with 5-year survival of 46% and 7-year survival of 39%
  • In that series of 100 patients, the 7 patients with positive lymph nodes had a median survival of 6 months, with 1-year survival of 43% and 2-year survival of 0%. The 93 patients without lymph node involvement had a median survival of 59 months.
  • In a cited study, 3-year survival after the combined treatment was 100%, 87%, 27% and 0% for tumor nuclear sizes of 10-20, 21-30, 31-40 and over 40 micrometres, respectively
• The authors' conclusion: The authors concluded that DMPM, once considered pre-terminal, can now be treated with curative intent by cytoreductive surgery and perioperative intraperitoneal chemotherapy at a referral center. They also stated that high-level comparative evidence is lacking and proposed a multi-institutional registry.
• Limitations the authors state:
  • The survival benefit of the combined treatment comes with moderate to high rates of complications and death
  • The combined treatment and traditional therapies have not been compared directly
  • There is a lack of high-level or comparative evidence on the safety and effectiveness of the combined treatment
  • Many centers report outcomes only for selected patients, who usually have favourable prognostic features

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Mesothelioma, Neoplasm, Asbestos Exposure, Median Overall Survival, Cytoreductive Surgery, Chemotherapy, Epidemiology.

Related studies

• Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma — T.C. Chua, T.D. Yan, et al. (2011)
• Evaluation of the cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy program — T.C. Chua, S. Martin, et al. (2010)
• Importance of gender in diffuse malignant peritoneal mesothelioma — C. Cao, T.D. Yan, et al. (2012)
• Surgical biology for the clinician: peritoneal mesothelioma: current understanding and management — T.C. Chua, T.D. Yan, et al. (2009)
• Computed tomographic characterization of malignant peritoneal mesothelioma — T.D. Yan, N. Haveric, et al. (2005)
• Peritoneal mesothelioma — M. Kannerstein, J. Churg (1977)

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