Diffuse malignant peritoneal mesothelioma--an update on treatment

Area of Science:

• Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Malignant peritoneal mesothelioma is an aggressive neoplasm, with asbestos exposure as the primary cause.
• Symptoms include ascites, abdominal pain, and weight loss, necessitating advanced diagnostic tools like CT scans and laparoscopy.
• Current palliative chemotherapy offers limited survival benefits.

Purpose of the Study:

• To review the evolving treatment landscape for malignant peritoneal mesothelioma.
• To highlight the advancements in locoregional therapies and their impact on patient survival.
• To describe the St. George hospital's experience with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Main Methods:

• Review of diagnostic modalities including imaging (CT, MRI, PET) and invasive procedures (laparoscopy).
• Analysis of treatment strategies, comparing palliative chemotherapy with locoregional approaches.
• Evaluation of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy.

Main Results:

• The combination chemotherapy of antifolate and platinum agents yields a median survival of 12-14 months.
• Locoregional therapy (cytoreductive surgery + perioperative intraperitoneal chemotherapy) has shown a 5-year survival rate of 29-63%.
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at St. George hospital demonstrated a significant survival advantage.

Conclusions:

• The prognosis for malignant peritoneal mesothelioma has significantly improved over the last decade.
• Locoregional therapy represents a promising curative option for eligible patients.
• Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is a key advancement in managing this disease.