Repeat CRS/HIPEC Improves Survival for Peritoneal Mesothelioma

One of the country’s top peritoneal mesothelioma surgeons has just published a study that may be good news for patients with this aggressive malignancy.

Paul Sugarbaker, MD, and colleagues at the Program in Peritoneal Surface Oncology in Washington, DC studied patients with diffuse peritoneal mesothelioma who had repeated cytoreductive surgery and heated intraperitoneal chemotherapy. Their results indicate that patients with diffuse peritoneal mesothelioma can safely undergo these procedures more than once and may even improve their odds of survival.

Cytoreductive surgery refers to a surgery designed to remove as much as possible of a mesothelioma tumor growing on the peritoneal lining that surrounds abdominal organs. Doctors have gotten good results by following the procedure with a wash of heated chemotherapy drugs (called HIPEC) through the abdomen before they close the incision in an effort to destroy any mesothelioma cells left behind after surgery.

In a new article in the Annals of Surgical Oncology, Dr. Sugarbaker and his team compared the rates of survival and complications among patients who underwent these procedures a second time after their mesothelioma began growing again with those of people who had the procedures only once. Of the 205 consecutive CRS/HIPEC cases studied, 44 (21.5%) were repeat procedures.

The team found that there were no deaths within 30 days after surgery among patients having a second CRS/HIPEC operation and the rate of serious complications was 2.3%. The median overall survival of patients undergoing repeat CRS/HIPEC was 54 months versus 77 months following an initial CRS/HIPEC operation.  The 3-year and 5-year survival rates among the two groups were very similar; sixty percent of mesothelioma patients who had CRS/HIPEC were alive 3 years after surgery while 61% of those who had the operation again lived for 3 years after the second operation.

“Iterative [repeat] CRS and HIPEC can be performed safely and appear to have benefits with this group of patients showing an improved median survival,” writes Chukwuemeka Ihemelandu, MD, Dr. Sugarbaker’s colleague and lead author on the paper.

The study found that patients with diffuse peritoneal mesothelioma were most likely to survive longer if they had the epithelioid subtype, experienced a complete or near-complete cytoreduction along with HIPEC, had no serious postoperative complications, and were younger. Women also tended to have a higher rate of mesothelioma survival than men.

Like all mesotheliomas, diffuse peritoneal mesothelioma is caused by exposure to asbestos. Although the increasing use of CRS/HIPEC has improved survival, there is no known cure.

Source:

Ihemelandu, C, “Iterative Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy or Recurrent or Progressive Diffuse Malignant Peritoneal Mesothelioma: Clinicopathologic Characteristics and Survival Outcome”, August 14, 2014, Annals of Surgical Oncology, Epub ahead of print