Peritoneal Mesothelioma Treated by Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy: Results of a Prospective Study
Monday, January 30th, 2006.
Annals of Surgical Oncology 2006 Jan 30; [Epub ahead of print]. [Link]
C. Brigand1, O. Monneuse2, 3, F. Mohamed4, A. C. Sayag-Beaujard5, S. Isaac6, F. N. Gilly3, 7 and O. Glehen3, 7
(1) Department of General Surgery, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
(2) Department of Emergency Surgery, Hôpital Edouard Herriot, Lyon, France
(3) Equipe Accueil 3738,
Faculté de Médecine Lyon-Sud, Oullins, France
(4) Department of General Surgery, Newcastle upon Tyne, United Kingdom
(5) Department of Anesthesiology, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
(6) Department of Pathology, Centre Hospitalier Lyon-Sud,
Pierre Bénite, France
(7) Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Pierre-Bénite Cédex, 69495, France
Abstract
Background: Peritoneal mesothelioma is a rare disease with few therapeutic options. Recently, the combination of cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (HIPEC) has shown promising results.
Methods: Fifteen patients with peritoneal mesothelioma who were treated by cytoreductive surgery and HIPEC between 1989 and 2004 were identified from a prospective database. HIPEC was performed with cisplatin and mitomycin C for 90 minutes by using the closed-abdomen technique.
Results: All patients but one (multicystic) had malignant disease of the following pathologic types: 12 epithelial and 2 biphasic. After surgical resection, 11 patients were considered to have a CC-0 or CC-1 resection (macroscopic complete resection or diameter of residual nodules <2.5 mm). No postoperative death occurred, and six postoperative complications were recorded. All but one patient had resolution of ascites. The overall median survival for the 14 patients with malignant mesothelioma was 35.6 months. The median survival was 37.8 months for patients treated with a CC-0 or CC-1 resection, whereas it was 6.5 months for those treated with a CC-2 or CC-3 resection (diameter of residual nodules >2.5 mm; P < .001). In a univariate analysis, the only other significant prognostic factor was the carcinomatosis extent (P = .02).
Conclusions: A therapeutic strategy combining cytoreductive surgery with HIPEC seems to provide an adequate and efficient locoregional treatment for peritoneal mesothelioma. It is associated with acceptable morbidity when performed by an experienced surgical team. The completeness of cytoreduction is the major determinant of survival.
Keywords: Peritoneal mesothelioma - Cytoreductive surgery - Intraperitoneal chemotherapy - Hyperthermia - Peritoneal carcinomatosis - Survival
Glossary
- resection
- surgery to remove part or all of an organ or other structure.
- oncology
- (on-call-o-jee) the branch of medicine concerned with the diagnosis and treatment of cancer.
- morbidity
- a measure of the new cases of a disease in a population; the number of people who have a disease.
- chemotherapy
- (key-mo-THER-uh-pee) treatment with drugs to destroy cancer cells. Chemotherapy is often used with surgery or radiation to treat cancer when the cancer has spread, when it has come back (recurred), or when there is a strong chance that it could recur.
- mesothelioma
- a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.
- peritoneal
- (pair-uh-tuh-nee-al) the serous membrane that lines the cavity of the abdomen. (More on Peritoneal Mesothelioma.)
- intraperitoneal chemotherapy
- (IPC) a form of regional chemotherapy; the flooding of the abdominal cavity with chemotheraputic drugs to target the cancer cells directly. It is sometimes heated to improve absorption of the anticancer drugs by the cancerous cells and because heat itself can kill cancer cells.
- ascites
- (uh-sigh-tees) excess fluid accumulation in the abdominal (peritoneal) cavity.
