Management of Malignant Peritoneal Mesothelioma Using Cytoreductive Surgery and Perioperative Chemotherapy

Our plain-English summary of Management of Malignant Peritoneal Mesothelioma Using Cytoreductive Surgery and Perioperative Chemotherapy, by P.H. Sugarbaker, K.K. Turaga, H.R. Alexander, et al (Journal of Oncology Practice, 2016).

The study

• Authors: P.H. Sugarbaker, K.K. Turaga, H.R. Alexander, M. Deraco, M. Hesdorffer
• Journal: Journal of Oncology Practice
• Published: 2016;12(10):928-935
• Cited by: 42 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant peritoneal mesothelioma is a rare disease, with approximately 800 new patients per year in the United States. Its natural history is defined by progression restricted to the peritoneal space. In the past, patients with this disease had a limited lifespan of approximately 1 year. Numerous single-institution studies as well as a systematic review have reported median survival of 3 to 5 years with a combination of cytoreductive surgery and hyperthermic perioperative chemotherapy. These markedly improved survival statistics were achieved in experienced centers with 1% mortality and 20% morbidity rates. Data have shown that knowledgeable patient selection is required to prevent patients unlikely to benefit from undergoing these interventions. The conclusion is that patients with peritoneal mesothelioma can experience long-term progression-free survival or significant palliation with cytoreductive surgery plus hyperthermic perioperative chemotherapy. This management plan should be considered the standard of care for properly selected patients with malignant peritoneal mesothelioma at experienced centers around the world.

In plain English

This article was a clinical review, not a new study. The authors summarized published research and gave recommendations on treating malignant peritoneal mesothelioma with cytoreductive surgery (removing visible tumor) followed by heated chemotherapy placed in the abdomen during the operation (HIPEC). They described how patients are diagnosed and selected. They gave a treatment algorithm that begins with a medical history that includes occupational exposure. The article did not study asbestos or any fiber exposure. A table adapted from a published systematic review of 20 studies reported median expected survival of 84% at 1 year and 42% at 5 years. In a multi-institutional report the authors cited, 188 of 401 patients (46%) had complications around the time of surgery, and nine (2%) died. The authors noted that there is no formal consensus on how to select patients. They also noted that there are no data from prospective clinical trials to guide the choice of HIPEC drug regimen. The authors concluded that this treatment should be considered the standard of care for properly selected patients at experienced centers.

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: Clinical review summarizing published studies and giving treatment recommendations
• Who was studied: No new patients were studied. The review drew on published studies of patients with malignant peritoneal mesothelioma, including a systematic review and meta-analysis whose data were adapted for a table covering 20 studies.
• Exposure: The article concerns a treatment (cytoreductive surgery plus hyperthermic perioperative chemotherapy), not an asbestos exposure. No fiber types were studied. The management algorithm lists taking a history that includes occupational exposure.
• Main results:
  • Across the 20 studies in the table adapted from a published meta-analysis, median expected survival was 84% at 1 year and 42% at 5 years.
  • Single-institution studies and a systematic review cited by the authors reported median survival of 3 to 5 years with this combined treatment.
  • In a cited report by Yan et al on 401 patients from eight institutions, 188 patients (46%) had perioperative complications, including 127 (31%) with grade 3 or 4 complications. Nine patients (2%) died perioperatively.
  • A cited study by Baratti et al reported 5-year survival of 40% with selective peritonectomy, compared with 63.9% with complete parietal peritonectomy.
  • A cited study by Ihemelandu et al reported 5-year survival of 46% among patients who had repeat surgery and HIPEC.
  • In the same cited study by Ihemelandu et al, 5-year survival was 52% among patients who had a single intervention with surgery and HIPEC.
  • A cited review by Miura et al of 1,591 US patients treated between 1973 and 2010 found that approximately three of every five patients did not receive surgery.
• The authors' conclusion: The authors concluded that cytoreductive surgery plus HIPEC should be considered the standard of care for properly selected patients with malignant peritoneal mesothelioma at experienced centers.
• Limitations the authors state:
  • The authors stated that no formal consensus exists on criteria for selecting patients for potentially curative treatment.
  • The authors stated that data from prospectively conducted clinical trials are lacking to establish which HIPEC regimen to use, so each institution's familiar regimen serves as its standard.
  • The authors stated that no adjuvant chemotherapy regimen has been studied extensively.
  • The authors stated that results at centers early in their experience may be considerably worse than at experienced centers.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Cytoreductive Surgery, Chemotherapy, Systematic Review, Median Overall Survival, Progression-Free Survival.

Related studies

• Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis — Y. Huang, N.A. Alzahrani, et al. (2017)
• Long-term survival outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy: Single-institutional experience with 1225 cases — L.S. Kyang, N.A. Alzahrani, et al. (2019)
• Long term survival and perioperative propensity score matched outcomes of diaphragmatic resections compared to stripping in cytoreductive surgery + intra-peritoneal chemotherapy — B. Singh, G. Singh, et al. (2020)
• Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy — E. Nizri, D. Baratti, et al. (2018)
• Radiological predictors of complete cytoreduction in 59 patients with peritoneal mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a UK referral centre — A. Chandramohan, A. Thrower, et al. (2017)
• Treating peritoneal mesothelioma with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A case series and review of the literature — K. Stamou, D. Tsamis, et al. (2015)

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