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Alexander HR. Perioperative Systemic Chemotherapy in Patients with Malignant Peritoneal Mesothelioma Undergoing Cytoreduction and HIPEC: Don't Put the Cart Before the Horse. Ann Surg Oncol 2023; 30:6301-6303. [PMID: 37358682 DOI: 10.1245/s10434-023-13783-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Affiliation(s)
- H Richard Alexander
- Division of Surgical Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Abstract
Background The clinical characteristics of malignant peritoneal mesothelioma are not fully known, and it appears as a variable entity with different types of clinical presentation and with a difficult diagnosis. Patients Fifteen patients with malignant peritoneal mesothelioma were analyzed for asbestos exposure, clinical presentation, thrombocytosis, X-rays and echotomographic findings, peritoneal fluid cytology, surgical investigations, diagnosis in vita, therapy, cause of death, diagnosis time, and survival time. Results Asbestos exposure was present in 12 men. Abdominal pain, ascites, abdominal mass, weight loss and fever were the most common presentation symptoms. In 5 patients, the disease presented as a surgical emergency. Assembling the presenting symptoms, malignant peritoneal mesothelioma was subdivided in 3 types: classical (6 cases), surgical (5 cases) and medical (4 cases). Thrombocytosis was present in 11 cases. Peritoneal fluid cytology was positive for neoplastic mesothelial cells in 8 of 10 cases. Laparotomy (5 patients) and laparoscopy (7 cases) were diagnostic in all cases. Diagnosis in vita was malignant peritoneal mesothelioma for 13 patients, peritoneal carcinomatosis for 1, with only 1 autopsy diagnosis. Seven patients were treated with chemotherapy, showing a progression of the disease. Mean symptoms-to-diagnosis time was 122 days (4-410), and mean symptoms-to-survival time was 345 days (45-1510). Conclusions Malignant peritoneal mesothelioma is a very unusual disease characterized by a difficult diagnosis, a rapid evolution, a poor response to therapy, and a very high prevalence of thrombocytosis. A new clinical classification into three types (classical, surgical and medical) may be useful for a correct diagnosis. The early diagnosis of malignant peritoneal mesothelioma remains an important open question.
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Affiliation(s)
- Vincenzo de Pangher Manzini
- Azienda per i Servizi Sanitari 2 Isontina, Ospedali di Monfalcone e Gorizia, Unità Operativa Complessa di Oncologia, Monfalcone, GO, Italy.
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Sugarbaker PH. Update on the management of malignant peritoneal mesothelioma. Transl Lung Cancer Res 2018; 7:599-608. [PMID: 30450299 PMCID: PMC6204413 DOI: 10.21037/tlcr.2018.08.03] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
Abstract
Malignant peritoneal mesothelioma (MPM) is a rare disease whose natural history is confined to the peritoneal space. Systemic chemotherapy has little impact on survival of patients with MPM. A surgical procedure with a goal of resection of all visible evidence of disease, called cytoreductive surgery (CRS) has been utilized in MPM patients. Also, regional chemotherapy with hyperthermic intraperitoneal chemotherapy (HIPEC) and normothermic intraperitoneal chemotherapy long-term (NIPEC-LT) have been effectively utilized in MPM patients. In the absence of CRS and HIPEC the median survival of MPM patients is approximately 1 year. The aggressive surgical approach plus regional chemotherapy has increased the median survival to more than 5 years. With NIPEC-LT added on, 70% 5-year survival has been reported. Knowledgeable patient selection for treatment is mandatory. The use of CRS, HIPEC and NIPEC-LT has greatly benefited patients with MPM. Global application of these treatments is indicated.
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Affiliation(s)
- Paul H Sugarbaker
- Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, Washington, DC, USA
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Sugarbaker PH, Turaga KK, Alexander HR, Deraco M, Hesdorffer M. Management of Malignant Peritoneal Mesothelioma Using Cytoreductive Surgery and Perioperative Chemotherapy. J Oncol Pract 2017; 12:928-935. [PMID: 27858561 DOI: 10.1200/jop.2016.011908] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Malignant peritoneal mesothelioma is a rare disease, with approximately 800 new patients per year in the United States. Its natural history is defined by progression restricted to the peritoneal space. In the past, patients with this disease had a limited lifespan of approximately 1 year. Numerous single-institution studies as well as a systematic review have reported median survival of 3 to 5 years with a combination of cytoreductive surgery and hyperthermic perioperative chemotherapy. These markedly improved survival statistics were achieved in experienced centers with 1% mortality and 20% morbidity rates. Data have shown that knowledgeable patient selection is required to prevent patients unlikely to benefit from undergoing these interventions. The conclusion is that patients with peritoneal mesothelioma can experience long-term progression-free survival or significant palliation with cytoreductive surgery plus hyperthermic perioperative chemotherapy. This management plan should be considered the standard of care for properly selected patients with malignant peritoneal mesothelioma at experienced centers around the world.
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Affiliation(s)
- Paul H Sugarbaker
- MedStar Washington Hospital Center, Washington, DC; University of Chicago, Chicago, IL; University of Maryland School of Medicine, Baltimore, MD; Mesothelioma Applied Research Foundation, Alexandria, VA; and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Kiran K Turaga
- MedStar Washington Hospital Center, Washington, DC; University of Chicago, Chicago, IL; University of Maryland School of Medicine, Baltimore, MD; Mesothelioma Applied Research Foundation, Alexandria, VA; and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - H Richard Alexander
- MedStar Washington Hospital Center, Washington, DC; University of Chicago, Chicago, IL; University of Maryland School of Medicine, Baltimore, MD; Mesothelioma Applied Research Foundation, Alexandria, VA; and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Marcello Deraco
- MedStar Washington Hospital Center, Washington, DC; University of Chicago, Chicago, IL; University of Maryland School of Medicine, Baltimore, MD; Mesothelioma Applied Research Foundation, Alexandria, VA; and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mary Hesdorffer
- MedStar Washington Hospital Center, Washington, DC; University of Chicago, Chicago, IL; University of Maryland School of Medicine, Baltimore, MD; Mesothelioma Applied Research Foundation, Alexandria, VA; and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Sugarbaker PH, Chang D. Long-term regional chemotherapy for patients with epithelial malignant peritoneal mesothelioma results in improved survival. Eur J Surg Oncol 2017; 43:1228-1235. [PMID: 28189456 DOI: 10.1016/j.ejso.2017.01.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/16/2016] [Accepted: 01/10/2017] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Malignant peritoneal mesothelioma (MPM) is a rare disease with about 300 new cases per year in the USA. Its natural history is described as local progression within the peritoneal space in the absence of liver metastases or systemic disease. METHODS Cytoreductive surgery (CRS) is a series of peritonectomy procedures and visceral resections with a goal of complete removal of all visible disease from the abdomen and pelvis. Over 20 years, three protocols investigating increasing efficacy of additional chemotherapy treatments added to CRS have been initiated. Initially, hyperthermic perioperative chemotherapy (HIPEC) with doxorubicin and cisplatin was used in the operating room. Then, early postoperative intraperitoneal chemotherapy (EPIC) with paclitaxel was added for the first 5 days after CRS. The third protocol employed HIPEC, then EPIC, and then long-term intraperitoneal (IP) paclitaxel or IP pemetrexed plus intravenous (IV) cisplatin as a adjuvant normothermic intraperitoneal chemotherapy (NIPEC). RESULT The 5-year survival of 42 patients treated with CRS and HIPEC was 44%, for 58 patients treated with EPIC and HIPEC was 52% and 29 patients who received HIPEC, EPIC, and NIPEC was 75% (p = 0.0374). Prognostic variables of age, gender, treatment administered, peritoneal cancer index (PCI) and completeness of cytoreduction were significant by univariate analysis and treatments administered and completeness of cytoreduction significant by multivariate analysis. CONCLUSIONS Long-term regional chemotherapy was associated with improved survival in patients with MPM. In this rare disease, additional phase 2 investigations are suggested.
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Affiliation(s)
- P H Sugarbaker
- Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, Washington, DC, USA.
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Leinwand JC, Bates GE, Allendorf JD, Chabot JA, Lewin SN, Taub RN. Body surface area predicts plasma oxaliplatin and pharmacokinetic advantage in hyperthermic intraoperative intraperitoneal chemotherapy. Ann Surg Oncol 2013; 20:1101-4. [PMID: 23456384 PMCID: PMC3599209 DOI: 10.1245/s10434-012-2790-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Indexed: 11/18/2022]
Abstract
Background Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) is used to treat peritoneal surface-spreading malignancies to maximize local drug concentrations while minimizing systemic effects. The pharmacokinetic advantage of HIPEC is defined as the intraperitoneal to intravascular ratio of drug concentrations. We hypothesized that body surface area (BSA) would correlate with the pharmacokinetic advantage of HIPEC. Because oxaliplatin is administered in 5 % dextrose, we hypothesized that BSA would correlate with glycemia. Methods We collected blood and peritoneal perfusate samples from ten patients undergoing HIPEC with a BSA-based dose of 250 mg/m2 oxaliplatin, and measured drug concentrations by inductively coupled plasma mass spectrophotometry. We monitored blood glucose for 24 h postoperatively. Areas under concentration-time curves (AUC) were calculated by trapezoidal rule. Pharmacokinetic advantage was calculated by (AUC[peritoneal fluid]/AUC[plasma]). We used linear regression to test for statistical significance. Results Higher BSA was associated with lower plasma oxaliplatin AUC (p = 0.0075) and with a greater pharmacokinetic advantage (p = 0.0198) over the 60-minute duration of HIPEC. No statistically significant relationships were found between BSA and blood glucose AUC or peak blood glucose levels. Conclusions Higher BSA is correlated with lower plasma drug levels and greater pharmacokinetic advantage in HIPEC, likely because of increased circulating blood volume with inadequate time for equilibration. Plasma glucose levels after oxaliplatin HIPEC were not clearly related to BSA.
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Affiliation(s)
- Joshua C Leinwand
- Division of Medical Oncology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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Kluger MD, Taub RN, Hesdorffer M, Jin Z, Chabot JA. Two-stage operative cytoreduction and intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma: Operative morbidity and mortality in phase I and II trials. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2010; 36:997-1003. [PMID: 20674253 DOI: 10.1016/j.ejso.2010.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 06/28/2010] [Accepted: 07/01/2010] [Indexed: 01/25/2023]
Abstract
AIMS The standard of care for diffuse malignant peritoneal mesothelioma involves operative cytoreduction and intraperitoneal chemotherapy. Most centers favor aggressive operative cytoreduction, accepting high morbidity and mortality. In our trials, patients underwent less extensive cytoreduction followed by prolonged intraperitoneal chemotherapy. Patients underwent a second cytoreduction with heated intraperitoneal chemotherapy. We hypothesized this would result in lower operative morbidity and mortality with similar survival. METHODS Hospital records, discharge summaries, microbiology, radiography, and office records were retrospectively reviewed to supplement a prospective database. 30-day morbidity and mortality were categorized, and classified according to the Clavien methodology. RESULTS 47 first and 39 second operations were performed with 13% and 26% morbidity, respectively. Mortality was 2%. Infections comprised 59% of the morbidity. Inclusive of both operations, formal peritonectomy was performed in 16% of patients, resection of isolated lesions in less than half, and only 19% had a visceral organs other than the spleen resected. At the completion of the protocol, only 3% of patients had visible intraperitoneal disease. The mean total length of stay for both operations combined was 16 ± 23 days. Overall median survival was 54.9 months, and median survival for the epithelioid subtype was 70.2 months. CONCLUSIONS A two-stage cytoreduction with intraperitoneal chemotherapy offers median survival comparable to one-stage protocols, with relatively low morbidity, mortality, visceral resections and length of stay despite two operations. This series supports that our protocol is a feasible and safe approach.
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Affiliation(s)
- M D Kluger
- Department of Surgery, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, New York 10032, USA
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8
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Combined resection, intraperitoneal chemotherapy, and whole abdominal radiation for the treatment of malignant peritoneal mesothelioma. Am J Clin Oncol 2008; 31:49-54. [PMID: 18376228 DOI: 10.1097/coc.0b013e3180684181] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We report a single-institution Phase I or II trial of surgical debulking, intraperitoneal chemotherapy, and immunotherapy followed by whole abdominal radiotherapy in patients with malignant peritoneal mesothelioma. METHODS Between 1997 and 2000, 27 patients with malignant peritoneal mesothelioma were enrolled: 23 with epithelial subtype and 4 with sarcomatoid or mixed subtype. The treatment regimen consisted of surgical debulking followed by 4 intraperitoneal courses of cisplatin alternating with 4 courses of doxorubicin, 4 doses of intraperitoneal gamma interferon, a second laparotomy with resection of residual disease plus intraoperative intraperitoneal mitomycin and cisplatin heated to 41 degrees C, and finally whole abdominal radiotherapy. RESULTS The median overall survival was 70 months with a 3-year survival of 67% (95% confidence interval, 46%-81%). Fourteen patients have died of their disease with a median time to death of 17 months (range, 0.4-71 months) after consenting to treatment. Seven patients are alive without evidence of disease with a median follow-up of 90 months (range, 71-110 months), and 6 are alive with disease with a median follow-up of 86 months (range, 70-106 months). The regimen was well tolerated. There were no patients with Grade III or IV hematological toxicities, 2 patients with Grade III ototoxicity, and 3 patients with Grade III gastrointestinal toxicity. CONCLUSION Based on the results of this study, intensive multimodality therapy appears feasible and effective in this group of patients.
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Hassan R, Alexander R. Nonpleural mesotheliomas: mesothelioma of the peritoneum, tunica vaginalis, and pericardium. Hematol Oncol Clin North Am 2006; 19:1067-87, vi. [PMID: 16325124 DOI: 10.1016/j.hoc.2005.09.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mesotheliomas are tumors that arise from the mesothelial cells of the pleura, peritoneum, pericardium, or tunica vaginalis. Although the number of new mesothelioma cases diagnosed each year in the United States seems to be leveling off or decreasing, several other countries are projected to have continued increased incidence of mesothelioma over the next several years. Of the approximately 2500 new cases of mesothelioma in the United States each year, most are pleural mesotheliomas. The peritoneum is the second most common site of mesothelioma development and accounts for approximately 10% to 20% of all mesotheliomas. Mesotheliomas that involve the pericardium or originate from the tunica vaginalis are rare tumors. Given the rarity of these tumors, it is difficult to obtain precise information regarding their incidence, natural history, and optimal management.
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Affiliation(s)
- Raffit Hassan
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 37 Convent Drive, Room 5116, Bethesda, MD 20892-4264, USA.
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Mahteme H, Larsson B, Sundin A, Khamis H, Graf W. Uptake of 5-fluorouracil (5-FU) in peritoneal metastases in relation to the route of drug administration and tumour debulking surgery. Eur J Cancer 2004; 40:142-7. [PMID: 14687798 DOI: 10.1016/s0959-8049(03)00667-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with peritoneal metastases from colorectal cancer have a poor prognosis. Aggressive treatment by debulking surgery and intraperitoneal (i.p.) chemotherapy has been suggested as an alternative therapy. However, the drug penetrance into the tumour in relation to the administration route and surgical reduction of the tumour is not well known. We compared locoregional administration with intravenous (i.v.) injection. Thirty-four in-bred rats with peritoneal metastases were randomly allocated into eight groups and injected with 14C-labelled 5-fluorouracil (5-FU) either through the i.v. or i.p. route, with or without a preceding tumour debulking, and were sacrificed after 2 or 8 h. Tumour radioactivity was visualised by autoradiography and quantified by a computer-based image analysis. After 8 h, 19 debulked and i.p.-injected tumours had a higher drug uptake, 63.2+/-28 (mean+/-standard deviation (SD)) kBq/g than 62 native i.p.-injected tumours (32.8+/-14) or 22 debulked and i.v.-injected tumours (18.5+/-18, P=0.002). After 8 h, 9 small tumours (<median 571 pixels) which underwent i.p. injection and tumour reduction had a higher drug uptake (77.4+/-26) than 29 non-debulked and i.p.-injected (35.1+/-17) or eight debulked and i.v. injected tumours (23.0+/-16, P=0.004). For larger tumours (>/=median 571 pixels), 16 debulked and i.p.-injected tumours had a higher radioactivity (drug uptake) (150.7+/-63) at 2 h than 49 i.p.-injected native tumours (48.5+/-59) or 11 reduced and i.v.-injected tumours (19.9+/-13, P=0.03). At 8 h, 10 debulked and i.p.-injected tumours had a higher drug uptake (50.3+/-24) than 33 native and i.p.-injected (30.8+/-10) or 14 debulked and i.v.-injected tumours (16.0+/-19, P=0.001). These results indicate that a debulking procedure and locoregional treatment of peritoneal metastases is associated with an increased level of 5-FU in the tumours.
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Affiliation(s)
- H Mahteme
- Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, S-751 85 Uppsala, Sweden.
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Abstract
This paper summarizes the author's thoughts about the use of cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy (CS-IPHC) for treatment of peritoneal malignant mesothelioma. Pleural malignant mesotheliomas are by far more common (about ten- to thirty-fold) than the peritoneal variants (2.2 cases per 1 million in the US). Other locations (pericardium, tunica vaginalis) are very rare. It is well known that chemotherapy for mesothelioma is largely unsatisfactory, and measurement of treatment responses can be difficult. Single agent responses are all less than 20% with currently available agents for systemically administered drugs. Multiple drug combinations are typically more toxic, and have yielded little consistent demonstrable benefit with major studies reporting median survivals consistently under a year. There is currently more attention being paid to the response category of "stable" or absence of disease progression in concert with quality of life measurements; all regimens show poor durability. With peritoneal malignant mesothelioma, malignant ascites is a common presentation and a major factor in disease-related morbidity and mortality. Interperitoneal administration of agents is attractive, but drug distribution is an issue, as are response rates and durability. Multiple treatments are required; further, all neoplasms with peritoneal dissemination are typically understaged by current radiologic tests (CT, MRI), and the variable uptake of sugar by the small bowel limits the use of positron-emission tomography (PET) imaging for peritoneal malignant mesothelioma. Also, symptoms of bowel obstruction are not uncommon, and any mechanical component of obstruction will not improve with any form of chemotherapy. The author's approach relies on surgery to achieve the following: 1) accurate staging; 2) tumor debulking, as possible, and treatment of mechanical obstruction as well as prevention of impending obstruction by resection or bypass; and 3) preparation for the use of intra-operative hyperthermic chemotherapy perfusion. This approach has been associated with rapid clinical symptom improvement, as well as a reliable and durable resolution of ascites with a single therapy. Morbidity and mortality have been acceptable with about 27-month median survival. The inability to provide effective systemic therapy to maintain or consolidate these gains is problematic.
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Affiliation(s)
- B W Loggie
- Department of Surgery, Division of Surgical Oncology, The University of Texas Southwestern Medical Center at Dallas, 1400 Eighth Avenue, Suite 101, Fort Worth, TX 76104, USA.
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Loggie BW, Fleming RA, Mcquellon RP, Russell GB, Geisinger KR, Levine EA. Prospective Trial for the Treatment of Malignant Peritoneal Mesothelioma. Am Surg 2001. [DOI: 10.1177/000313480106701019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Malignant peritoneal mesothelioma (MPM) is a rare and often rapidly fatal disease with median survival of 5 to 12 months for untreated cases and 16 months reported after multimodality treatment. We report a prospective clinical treatment study using cytoreductive surgery combined with intraoperative intraperitoneal heated chemotherapy (IPHC) perfusion using mitomycin C for MPM. Twelve patients (11 male with a mean age 51 years) were treated. Seven patients presented with bulky disease and seven with ascites. All underwent exploratory laparotomy with histologically confirmed diagnosis of MPM. Surgical debulking as feasible was performed. Complete gross tumor removal was possible in only one patient. Cytoreduction was followed by a 2-hour closed low-volume IPHC using mitomycin C. One patient died 50 days postoperatively from complications relating to small bowel perforation. Hematologic toxicity of the procedure was minimal. Ascites was controlled in all patients and permanently in 86 per cent of patients presenting with ascites. To date median survival is 34.2 months with median follow-up of 45.2 months. One patient was re-explored for ventral hernia 2 years post-IPHC, had negative peritoneal biopsies, and remains disease-free at 5 years. Given the dismal prognosis associated with MPM the results of treatment with cytoreductive surgery combined with IPHC perfusion are encouraging. The rarity of MPM makes appropriately powered prospective randomized trials unlikely. Therefore, we now offer this approach off protocol; however, further study of this combined modality therapy is warranted.
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Affiliation(s)
- Brian W. Loggie
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Ronald A. Fleming
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | | | - Gregory B. Russell
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Kim R. Geisinger
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Edward A. Levine
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
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Cuschieri A. Role of video-laparoscopy in the staging of intra-abdominal lymphomas and gastrointestinal cancer. SEMINARS IN SURGICAL ONCOLOGY 2001; 20:167-72. [PMID: 11398209 DOI: 10.1002/ssu.1029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is good category II/III evidence that video-laparoscopic staging is valuable in certain gastrointestinal (gastric, esophageal, pancreatic, and hepatobiliary) and intra-abdominal lymphomas, but no category I evidence (based on prospective randomized trials). The evidence available is all retrospective, but of sufficient consistency to indicate that laparoscopic staging adds to the primary (imaging) staging and often alters the clinical stage of the disease and hence the management of the individual patient. The advent of laparoscopic contact ultrasound (LCU) scanning has improved the staging accuracy for pancreatic and hepatobiliary neoplasms. The laparoscopic approach also offers a means of surgical palliation in certain patient groups. However, there are a number of unresolved issues concerning the use of video-laparoscopy. The most important concerns whether staging laparoscopy should be performed immediately before scheduled surgery or as a separate intervention. The cost-efficacy of these two management options needs to be evaluated in prospective studies. In some centres, laparoscopic staging is being conducted by gastroenterologists and hepatologists. This raises issues of safety and ability to undertake certain procedures that may be necessary during the laparoscopic staging.
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Affiliation(s)
- A Cuschieri
- Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee, Scotland.
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Piazza D, Caruso F, Scaringi S, Ferrara M, Latteri F, Dell'Erba D. Primary diffuse malignant peritoneal mesothelioma: case report and update of therapy. J Surg Oncol 2000; 75:55-8. [PMID: 11025463 DOI: 10.1002/1096-9098(200009)75:1<55::aid-jso10>3.0.co;2-d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Primary Diffuse Malignant Peritoneal Mesothelioma is a rare disease, with an incidence of 2.2 cases in 1. 000.000 in the USA. It occupies 10% of all mesotheliomas referred in literature. METHODS We describe a case of diffuse malignant peritoneal mesothelioma arising in a 54-year-old woman who presented a small bowel occlusion. A middle line laparotomy was done; multiple biopsies and an ileostomy were performed. There was not a history of exposure to asbestos. Histologic diagnosis was based on light microscopy, histochemistry, and immunohistochemistry. RESULTS Patient had no further treatment because of her poor general conditions. She died 4 months later. CONCLUSIONS Update of treatment is briefly described with particular attention to multimodality approach (surgery, chemotherapy, radiotherapy) and other new therapeutic options (iperthermochemotherapy, immunotherapy, gene therapy), currently in clinical trials.
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Affiliation(s)
- D Piazza
- University of Catania, Catania, Italy
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Wengrower D, Sweedan W, Gips M, Felig Y, Goldin E. Malignant peritoneal mesothelioma: mucosal duodenal involvement and endoscopic diagnosis. Gastrointest Endosc 2000; 52:270-2. [PMID: 10922109 DOI: 10.1067/mge.2000.107216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- D Wengrower
- Gastroenterology Department, Oncology Department, and Pathology Department, Hadassah University Hospital and Augusta Victoria Hospital, Jerusalem, Israel.
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