Cancer researchers at Wake Forest University have found another benefit to the cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) combination used to treat peritoneal mesothelioma and other abdominal cancers: the control of fluid buildup.
Fluid accumulation in the abdomen because of peritoneal mesothelioma or another type of cancer is known as ascites. Left untreated, ascites can cause bloating, discomfort, disfiguration, and shortness of breath when it interferes with the movement of the diaphragm. While patients with peritoneal mesothelioma, an aggressive cancer of the peritoneal surface, can have this fluid drained off, it often reaccumulates. But the new Wake Forest research suggests that CRS/HIPEC may offer a more permanent solution.
Fifteen percent of the cancer patients in the study had peritoneal mesothelioma. The rest had various types of primary cancers that had spread to the peritoneum. All patients in the study underwent cytoreductive surgery to remove as much of the cancer as possible, followed by a rinse of heated chemotherapy drugs in their abdomen to destroy residual cancer cells.
Of the 299 patients with ascites who were treated with CRS/HIPEC, 288 (93%) had a complete resolution of their ascites after three months, even in cases where the cancer itself could not be completely removed. Summarizing their findings in the Annals of Surgical Oncology, the authors write, “Although complete cytoreduction remains the goal of this procedure, HIPEC can provide palliative value in selected patients with malignant ascites.”
According to the study, the presence of ascites in mesothelioma and other abdominal cancers is predictive of incomplete cytoreduction and worse overall survival. But the results suggest that, by controlling the ascites, CRS/HIPEC can help improve quality of life for mesothelioma patients, even in cases where it may not be able to improve survival.
Randle, RW, et al, “Efficacy of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in the Management of Malignant Ascites”, August 28, 2013, Annals of Surgical Oncology, Epub ahead of print.