A new study out of Italy has some encouraging news for patients with the peritoneal form of malignant mesothelioma. The recent analysis of 108 peritoneal mesothelioma patients who underwent complete cytoreductive surgery (CRS) followed by a rinse of heated chemotherapy (HIPEC) found a 43.6% cure rate among long-term survivors.
Peritoneal mesothelioma is a rare form of one of the rarest cancers. Triggered almost exclusively by exposure to asbestos, mesothelioma affects about 2,500 Americans each year. About a third of those patients are diagnosed with the peritoneal form of the disease, which occurs on the membrane that lines the abdomen and surrounds the internal organs.
During cytoreductive surgery, surgeons attempt to remove all traces of the mesothelioma tumor so that no cells are left that could begin growing again. It involves stripping off the peritoneum and removing any residual lesions that have spread to the surfaces of internal organs. A heated solution of chemotherapy medicines is then put into the abdominal cavity in order to kill any residual cells.
The newest study of the technique, published in the European Journal of Cancer, looked at the results of 108 cytoreductive surgeries that were followed by HIPEC with cisplatin and doxorubicin or mitomycin-C. Twenty-seven variables, including patient factors, factors related to the tumor, and those related to the mesothelioma treatment, were assessed using a technique called multivariate analysis. The tumor cells were also tested using a list of immunohistochemical markers.
Although 38.9% of the peritoneal mesothelioma patients experienced major complications after the CRS/HIPEC procedure and nearly 2% died, the median overall survival for all patients was 63.2 months. Most patients went more than 2 years (median of 25.1 months) before their mesothelioma began to grow again. And a number of patients in the analysis survived much longer. “The survival curve reached a plateau after 7 years, representing 19 actual survivors of 39 patients (43.6%),” the authors wrote in a published summary of their results.
According to the study, long-term survival among peritoneal mesothelioma patients after CRS/HIPEC was “primarily dependent on pathologic and biologic features.” Having the epithelial subtype of the disease and no cancer in the lymph nodes correlated with increased overall survival and progression-free survival.
Baratti, D, “Diffuse malignant peritoneal mesothelioma: Long-term survival with complete cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC)”, July 4, 2013, European Journal of Cancer, Epub ahead of print.