Peritoneal Mesothelioma in a High Volume Peritoneal Surface Malignancies Unit

Our plain-English summary of Peritoneal Mesothelioma in a High Volume Peritoneal Surface Malignancies Unit, by F. Pereira, M. Pereira, I. Manzanedo, et al (Journal of Clinical Medicine, 2023).

The study

• Authors: F. Pereira, M. Pereira, I. Manzanedo, Á. Serrano, E. Pérez-Viejo
• Journal: Journal of Clinical Medicine
• Published: 2023;12(6)
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Diffuse malignant peritoneal mesothelioma (PM) is a rare neoplasm, traditionally associated with a poor prognosis. There are other varieties of PM that are even less frequent and of uncertain malignancy. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has achieved prolonged survival in selected patients. The aim of this study is to analyze the patients with PM assessed in our center. Clinicopathological characteristics, diagnostic procedures and survival results from patients with PM appraised at our unit, according to the applied treatment, were analyzed. Seventeen patients were assessed between 2007 and 2019. Three cases had multicystic PM that were treated with complete CRS + HIPEC; all patients are alive and free of disease after a long follow-up. Three other cases had biphasic PM; a curative treatment could be performed in none of them, and their survival was minimal (<6 moths). Lastly, 11 cases with epithelioid PM were treated. Two cases were considered unresectable at laparoscopy (PCI 39); one of them had a long survival (67 months) with three iterative laparoscopic palliatives HIPECs for refractory ascites. The other nine cases were treated with curative CRS + HIPEC, with a median PCI of 14 (range 4-25), and a median overall survival (OS) of 58 months, with a 5-year OS of 47.4%. In conclusion, CRS + HIPEC, when possible, appears to be the optimal treatment for patients with PM. Knowledge of this therapeutic option is crucial, both to offer it to patients and to avoid delays in their referral to appropriate centers for treatment.

In plain English

This article described 17 patients with peritoneal mesothelioma (a tumor of the abdominal lining) assessed from 2007 to 2019 at one specialist surgical unit in Madrid, Spain. The treatment studied was surgery to remove visible tumor (cytoreductive surgery) plus heated chemotherapy delivered into the abdomen (HIPEC). Asbestos exposure was recorded for one patient, who had the epithelioid type. All three women with multicystic mesothelioma had complete surgery plus HIPEC and were alive and free of disease after a median follow-up of 59 months. None of the three patients with biphasic mesothelioma could receive curative treatment. One died 5 days after emergency surgery and the other two survived 6 months. Of 11 patients with epithelioid mesothelioma, nine had surgery plus HIPEC aimed at cure. Their median overall survival was 58 months; estimated 5-year overall survival was 47.4%. One of the nine died after surgery, and five of the other eight relapsed. The authors said no conclusions about surgical death rates could be drawn from such a small series. They concluded that this treatment, in correctly selected patients, seems to be the optimal treatment.

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: Single-center case series of patients with peritoneal mesothelioma, analyzed by tumor type and treatment received
• Who was studied: 17 patients with peritoneal mesothelioma (3 multicystic, 3 biphasic, 11 epithelioid) assessed at the Peritoneal Surface Malignancies Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain, from 2007 to 2019; 5 were first evaluated at this center and 12 were referred from elsewhere
• Exposure: The study examined treatment (cytoreductive surgery with HIPEC using cisplatin and doxorubicin), not asbestos. Table 1 records asbestos exposure in 0 multicystic, 0 biphasic and 1 epithelioid patient; no fiber type or job is given.
• Main results:
  • Multicystic peritoneal mesothelioma (3 women): all had complete cytoreductive surgery plus HIPEC, and all were alive and disease-free after a median follow-up of 59 months (range 33–127)
  • Biphasic peritoneal mesothelioma (3 patients): none could be treated with curative intent. One patient aged 83 died 5 days after urgent palliative surgery; the other two received palliative chemotherapy and survived 6 months.
  • Epithelioid peritoneal mesothelioma, two unresectable patients (PCI 39): one, treated with three laparoscopic palliative HIPECs for ascites, survived 67 months; the other was lost to follow-up after 4 months
  • Epithelioid peritoneal mesothelioma, nine patients treated with surgery plus HIPEC aimed at cure (median PCI 14, range 4–25): median follow-up 49 months, median overall survival 58 months, estimated 5-year overall survival 47.4%, median disease-free survival 17 months, estimated 4-year disease-free survival 38% (survival estimated with the Kaplan–Meier method)
  • Complications in the nine epithelioid patients: one died on the 11th day after surgery; severe complications in 22.2% (2/9, including the death); complications of any grade in 66.6% (6/9)
  • Of the eight epithelioid patients who survived curative-intent surgery, five relapsed (four in the peritoneum, one in an axillary lymph node)
  • Across all 13 curative-intent surgery plus HIPEC procedures (multicystic and epithelioid), there was one postoperative death (1/13 = 7.6%)
• The authors' conclusion: The authors concluded that surgery plus HIPEC, in correctly selected patients, seems to be the optimal treatment for peritoneal mesothelioma, and that knowing about this option matters for offering it to patients and avoiding delays in referral to specialist centers.
• Limitations the authors state:
  • The series is too small to draw conclusions about the postoperative death rate
  • The authors say the disease-free survival figure underestimates the real benefit, because it counts only up to the first relapse and two relapses were later completely removed

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Neoplasm, Prognosis, Cytoreductive Surgery, HIPEC, Biphasic Mesothelioma, Epithelioid, Unresectable.

Related studies

• The Safety of Iterative Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis: A High Volume Center Prospectively Maintained Database Analysis — E. Bekhor, J. Carr, et al. (2020)
• Efficacy and Insights from an Extensive Series of Cytoreductive Surgery for Peritoneal Neoplasms: A High-Volume Single-Center Experience — M. Aulicino, F. Santullo, et al. (2024)
• Drugs, doses, and durations of intraperitoneal chemotherapy: standardising HIPEC and EPIC for colorectal, appendiceal, gastric, ovarian peritoneal surface malignancies and peritoneal mesothelioma — L. Lemoine, P. Sugarbaker, et al. (2017)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• Dose-Dependent Effect of Red Blood Cells Transfusion on Perioperative and Long-Term Outcomes in Peritoneal Surface Malignancies Treated with Cytoreduction and HIPEC — E. Nizri, S. Kusamura, et al. (2018)
• Feasibility and outcomes of cytoreductive surgery and HIPEC for peritoneal surface malignancies in low- and middle-income countries: a single-center experience of 232 cases — S. Deo, M. Ray, et al. (2021)

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