Peritoneal mesothelioma

Our plain-English summary of Peritoneal mesothelioma, by A. Greenbaum, H.R. Alexander (Translational Lung Cancer Research, 2020).

The study

• Authors: A. Greenbaum, H.R. Alexander
• Journal: Translational Lung Cancer Research
• Published: 2020;9(Suppl 1):S120-S132
• Type of article: Review
• Cited by: 49 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare and lethal disease of the peritoneal lining, with high variability in biologic aggressiveness. Morbidity and mortality of the disease are related to progressive locoregional effects within the abdominal cavity, such as distention, pain, early satiety, and decreased oral intake that can ultimately lead to bowel obstruction and cachexia. The standard of care for patients with resectable disease remains cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), with potential survival outcomes greater than 5 years in appropriately selected patients. Patients with inoperable MPM can be offered systemic treatment, although the disease is usually refractory to standard chemotherapic regimens. Patients with MPM should be treated at high volume centers with strong consideration for inclusion in tumor registries and clinical trials. In 2020, research will continue to explore promising genetic and immunologic targets and focus on refinement of surgical methods to optimize CRS-HIPEC approaches.

2020 Translational Lung Cancer Research. All rights reserved.

In plain English

This was a review article, not a new study. The two authors summarized published research on malignant peritoneal mesothelioma, a rare cancer of the lining of the abdomen. They covered risk factors, diagnosis, staging, surgery, chemotherapy, and research on genetic and immune targets. On causes, the review said asbestos remained the most identifiable risk factor. It also said peritoneal cases have been linked to asbestos less often than pleural cases: as few as 8% of peritoneal patients reported previous exposure, compared with more than 80% of pleural patients. The review named the silicate fiber erionite as another potent cause. On treatment, it described earlier studies of surgery to remove tumor followed by heated chemotherapy placed inside the abdomen (CRS-HIPEC). One 2009 multi-institutional study of 405 patients reported a median overall survival of 53 months and a 5-year survival of 47%. The authors concluded that CRS-HIPEC remains the standard of care for disease that can be removed surgically. They said the disease is usually resistant to standard chemotherapy and that patients should be treated at high-volume 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: Narrative review of published literature on malignant peritoneal mesothelioma (risk factors, diagnosis, staging, surgery, chemotherapy, genetic and immune research)
• Who was studied: No patients were studied directly. The review covered published studies of patients with malignant peritoneal mesothelioma, mostly in the United States and Europe.
• Exposure: Asbestos was discussed as the most identifiable risk factor. Erionite and other factors (therapeutic radiation, Thorotrast dye, viruses, chronic inflammation) were also mentioned. The main subject was treatment (CRS-HIPEC and systemic chemotherapy), not exposure.
• Main results:
  • The review stated, citing other publications, that peritoneal mesothelioma has been linked to asbestos less often than the pleural form. As few as 8% of peritoneal patients identified previous exposure, compared with more than 80% of pleural patients.
  • The review stated that peritoneal mesothelioma usually occurs around 20 years after exposure, compared with 30 to 40 years for pleural mesothelioma.
  • The review named the silicate fiber erionite as a potent inducer of peritoneal mesothelioma.
  • The review cited a 2009 multi-institutional study by Yan et al. of 405 peritoneal mesothelioma patients treated with CRS-HIPEC. That study reported a median overall survival of 53 months and a 5-year overall survival of 47%.
  • The review cited a SEER database study of 1,591 patients. In that study, overall survival improved to 38 months in 2006 to 2010, compared with 15 months in 1991 to 1995 (P=0.01).
  • For systemic chemotherapy, the review reported an estimated median overall survival of 8.7 months with pemetrexed alone, compared with 13.1 months with pemetrexed plus cisplatin.
• The authors' conclusion: The authors concluded that CRS-HIPEC remains the standard of care for resectable disease, with potential survival of more than 5 years in carefully selected patients. They said inoperable disease can be treated with systemic therapy but is largely resistant to standard chemotherapy. They concluded that patients should be treated at high-volume centers, with strong consideration of tumor registries and clinical trials.
• Limitations the authors state:
  • The authors noted that it is difficult to conclude which heated chemotherapy regimen works best, because the existing studies are retrospective.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Early Satiety, Cachexia, Cytoreductive Surgery, HIPEC, Clinical Trial.

Related studies

• Treatment of primary peritoneal mesothelioma by continuous hyperthermic peritoneal perfusion (CHPP) — B.J. Park, H.R. Alexander, et al. (1999)
• Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma — H.R. Alexander, D.L. Bartlett, et al. (2013)
• Management of Malignant Peritoneal Mesothelioma Using Cytoreductive Surgery and Perioperative Chemotherapy — P.H. Sugarbaker, K.K. Turaga, et al. (2016)
• A novel nomogram for peritoneal mesothelioma predicts survival — N.P. Schaub, M. Alimchandani, et al. (2013)
• Current concepts in the evaluation and treatment of patients with diffuse malignant peritoneal mesothelioma — K. Turner, S. Varghese, et al. (2012)
• Multipotent cancer stem cells derived from human malignant peritoneal mesothelioma promote tumorigenesis — S. Varghese, R. Whipple, et al. (2012)

Browse more research in Translational Lung Cancer Research, or return to medical research.