Completeness of surgery, tumor grade, and the use of the chemotherapy drug cisplatin all have an impact on survival after peritoneal mesothelioma surgery and heated intraoperative chemotherapy, according to recent studies. Peritoneal mesothelioma is a cancer of the abdominal wall. This type of mesothelioma is often treated by surgery to remove as much of the cancer as possible (Cytoreductive surgery or CRS) followed by a wash of heated chemotherapy drugs through the open body cavity (HIPEC).
Two recent studies – one conducted in the U.S. and one in Singapore – have independently confirmed a list of factors that contribute to survival after CRS and HIPEC for peritoneal mesothelioma. The first study included 211 peritoneal mesothelioma patients treated with CRS and HIPEC at 3 major referral centers between January 1992 and 2010.
Researchers at the University of Maryland found 5- and 10-year survival rates of 41% and 26% respectively among the peritoneal mesothelioma patients treated with this approach. Overall survival was 38.4 months. Factors associated with favorable outcomes were younger age (younger than 60), complete or near complete surgical resection, low grade of tumor, and the use of the drug cisplatin instead of mitomycin-C. Cisplatin improved survival even in patients who did not have other factors in their favor. The study also confirmed that women with mesothelioma tended to respond better to treatment than men.
Another study conducted at the National Cancer Centre Singapore on 100 patients with various types of abdominal cancer, including mesothelioma, produced similar results. That study, which followed patients for 21 months after CRS and HIPEC, found that completeness of surgery (expressed as ‘cytoreductive score’) had the greatest influence on survival. At 5 years, the disease-free survival for all patients studied was 26.3% and overall survival was 50.9%. None of the patients died within a month of surgery. This study concluded that “careful patient selection ensuring that optimal cytoreduction can be achieved is essential for the success of this procedure.”
Teo, MC et al, “Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Asian Patients: 100 Consecutive Patients in a Single Institution”, March 17, 2013, Annals of Surgical Oncology, Epub ahead of print.