If one cytoreductive surgery and HIPEC procedure for mesothelioma is good, subsequent treatments may be even better. That is the central message of research conducted at the Moffitt Cancer Center in Florida. The study’s aim was to assess overall survival among peritoneal mesothelioma patients who had not just one, but two or more rounds of heated intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery.
The cytoreduction/HIPEC approach has become popular for peritoneal mesothelioma, a treatment-resistant cancer of abdominal membranes caused by asbestos. Cytoreductive surgery involves removing as much of the mesothelioma tumor as possible from the abdomen. Because the shape and spreading pattern of mesothelioma tumors make complete cytoreduction difficult, the surgery is often followed by a rinse with a heated solution of chemotherapy drugs to kill as many residual cancer cells as possible.
The new study focused on 29 patients who underwent surgery for peritoneal mesothelioma at Moffitt between June 2004 and March 2012. All but three of these patients also had the HIPEC treatment right after surgery. Of these, 8 patients returned later to have a second HIPEC procedure in an effort to slow or stop the regrowth of their mesothelioma.
Overall, there were no major differences for these patients between their first and second surgeries. They experienced similar lengths of surgery, blood loss, and hospital stays and the same drug (cisplatin) was used for their HIPEC. Patients did tend to experience fewer complications after their second HIPEC treatment than they did after their first (50% vs. 65% after first treatment).
But the biggest difference was seen between the mesothelioma patients who had only one cytoreductive surgery/HIPEC treatment and those who had a second HIPEC procedure. Median overall survival for all of the peritoneal mesothelioma patients in the study was 41.2 months. Patients who had one surgery and just one round of HIPEC had a median survival of 27.2 months. But patients who underwent repeat HIPEC experienced significantly longer survival with a median overall survival of 80 months.
Summarizing their findings in the Annals of Surgical Oncology, Dr. Joyce Wong and colleagues conclude, “Cytoreduction and HIPEC for malignant peritoneal mesothelioma are associated with longer overall survival. Patients who are candidates for repeat HIPEC may derive an even greater overall survival advantage.”
Peritoneal mesothelioma accounts for less than 30 percent of the 2,500 mesothelioma cases that occur in the U.S. each year.
Wong, J, et al, “Repeat Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy May Offer Survival Benefit for Intraperitoneal Mesothelioma: A Single Institution Experience”, October 25, 2013, Annals of Surgical Oncology, Epub ahead of print.