Extended Survival of Peritoneal Mesothelioma with Repeat Treatment

There is some good news on the research front for patients with recurrent peritoneal mesothelioma. Doctors at the University of New South Wales in Australia say that treating these patients again with surgery and heated chemotherapy is extending lives, sometimes for several years.

Peritoneal mesothelioma, which accounts for about 20 percent of mesothelioma cases, occurs on the peritoneal membrane that surrounds abdominal organs. Cytoreductive surgery (CRS) aims to remove as much of that diseased tissue as possible. It is often followed by heated intraperitoneal chemotherapy (HIPEC) to kill any remaining mesothelioma cells and to keep new tumors from starting.

The CRS/HIPEC combination has become the gold standard first line treatment for peritoneal mesothelioma. But the authors of a new study in the European Journal of Surgical Oncology say it is also a promising second- or even third-line therapy option.

The researchers conducted a retrospective study on 44 consecutive peritoneal mesothelioma patients who underwent at least one round of CRS and HIPEC at St. George Hospital in Sydney, Australia. All patients had the same surgical team and some had as many as four CRS/HIPEC treatments when their mesothelioma came back. A total of 58 operations were performed on the 44 mesothelioma patients.

“We report an encouraging median survival of 62 months in patients who had recurrence of disease and had repeat CRS and HIPEC with similar morbidity and mortality with the initial operation,” writes author Yeqian Huang of the St. George Clinical School at the University of New South Wales.

In fact, there were no significant differences in complications or deaths among the mesothelioma patients who had only one operation and those who had as many as four. This suggests that there is little physical downside to retreating patients with CRS and HIPEC.

The catch is that the technique for retreatment with CRS and HIPEC is complex and has a high learning curve.  For the best outcomes, the authors suggest that patients with recurrent peritoneal mesothelioma be referred to centers that specialize in this type of operation.

Source:

Huang, Y, et al, “Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent malignant peritoneal mesothelioma”, July 16, 2015, European Journal of Surgical Oncology, Epub ahead of print