Patients who have radical surgery for peritoneal mesothelioma live longer than those who have non-surgical treatments.
That is the conclusion of a team of Virginia researchers. The study is based on peritoneal mesothelioma cases in the National Cancer Database. It spans more than a decade and includes over 2,000 patients.
Not everyone is a candidate for radical surgery for peritoneal mesothelioma. But the research shows that those who have surgery live an average of five times longer than those who do not.
Surgical Treatment of Peritoneal Mesothelioma
Peritoneal mesothelioma is sometimes called diffuse malignant peritoneal mesothelioma. It is an aggressive cancer in the abdomen. It grows on the membrane around organs. Because mesothelioma tumors lie so close to these organs, it is easy for the cancer to spread.
Radical surgery for peritoneal mesothelioma involves removing the diseased membrane. Surgeons may also have to remove tumors from other parts of the abdomen.
By the time patients receive a mesothelioma diagnosis, it is sometimes too late for radical surgery. If the cancer is too widespread, or if the patient is not in good enough health, patients may have chemotherapy instead.
But the new study finds that survival after chemotherapy is not nearly as high as it is after radical surgery. A combination of radical surgery for peritoneal mesothelioma and intraperitoneal chemotherapy (HIPEC) produced the best odds of survival.
Evaluating Radical Surgery for Peritoneal Mesothelioma
The new study uses data from the National Cancer Database. It focused on 2,062 peritoneal mesothelioma patients diagnosed between 2003 and 2014.
More than half (51%) of the patients did not have surgery. Most of these patients just had chemotherapy with Alimta. This group of patients had a median overall survival of 7.1 months.
Seven-hundred-and-one patients (34%) had aggressive treatment with radical surgery for peritoneal mesothelioma. Overall survival in this group was 38.4 months. Among those who also had a rinse of heated chemotherapy during surgery (HIPEC), overall survival jumped to 41.8 months.
“Patients selected for and treated with radical surgery had significantly better overall survival compared with those receiving nonsurgical treatment,” writes Lana Bijelic. Dr. Bijelic is medical director of surgical oncology at Inova Fairfax Hospital. She is first author on the paper in the Annals of Surgical Oncology.
Dr. Bijelic and her colleagues recommend that all newly-diagnosed patients be evaluated for radical surgery for peritoneal mesothelioma.
According to the CDC, more than 45,000 people died of all forms of mesothelioma between 1999 and 2015. Peritoneal mesothelioma accounts for about a fifth of those cases. It takes an average of 20 to 40 years for peritoneal mesothelioma to develop after asbestos exposure.
Bijelic, L, et al, “Predictors and Outcomes of Surgery in Peritoneal Mesothelioma: an Analysis of 2000 Patients from the National Cancer Database”, January 31, 2020, Annals of Surgical Oncology, Epub ahead of print, https://link.springer.com/article/10.1245%2Fs10434-019-08138-5