Thanks to the combination mesothelioma treatment approach of cytoreductive surgery and perioperative intraperitoneal chemotherapy (PIC), the survival odds for patients with peritoneal mesothelioma are better than ever. But patients considering this type of treatment should also be aware of the “learning curve” associated with it.
This learning curve is the focus of a newly-released study from the University of New South Wales in Australia, a country with one of the highest per capita rates of mesothelioma in the world. Doctors tracked the outcomes for 800 patients with peritoneal mesothelioma or another type of abdominal cancer who underwent CRS and PIC between 1996 and 2014.
The analysis showed that the patients who had treatment most recently tended to fare better than those treated years ago. These patients not only had more complete removal of their tumors (74% among the earliest patients vs. 83% among the most recent), but were also much less likely to experiences complications such as fistulas and small bowel obstructions. They were also less likely to need blood transfusions.
Not every aspect of the treatment was better for the most recent mesothelioma patients, though. The study found an increase in the rate of serious post-surgical problems like deep vein thrombosis and pulmonary embolism (blood clots). Overall, however, the five-year survival rate had improved for CRS/PIC patients with colorectal cancer, pseudomyxoma peritonei, and mesothelioma, prompting the researchers to conclude that more experience leads to better outcomes.
“Our findings demonstrate a learning curve associated with the combined approach of CRS and PIC,” writes lead author Yeqian Huang, MD, of the St. George Clinical School at the University of New South Wales. “With adequate experience, CRS and PIC can be safely performed with acceptable mortality and morbidity.”
Like all forms of mesothelioma, peritoneal mesothelioma is linked to asbestos exposure. It occurs on the membrane that surrounds abdominal organs and accounts for about 500 of the 2,500 cases of mesothelioma in the US each year.
Huang, Y, et al, “Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis”, September 2, 2015, ANZ Journal of Surgery, Epub ahead of print