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Published on: July 31, 2016
Treatment of diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery and HIPEC
M Robella1, M Vaira, A Mellano
1Unit of Surgical Oncology, IRCCS (Scientific Institute for Cancer Research and Treatment), Candiolo, Turin, Italy - manuela.robella@hotmail.it.
Aim:
Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and locally aggressive tumor with poor prognosis, related in most cases to asbestos exposure. It is increasing in frequency, but currently no standard therapy is available. The biology of this disease is still poorly understood. Several highly specialized centers have recently reported improved survival by means of an innovative local-regional approach. The purpose of this article is to evaluate the survival benefit and the morbidity rate of patients affected by DMPM treated at our institution by cytoreductive surgery (CRS) associated with hyperthermic intraperitoneal perioperative chemotherapy (HIPEC).
Methods:
This study includes 42 patients affected by DMPM treated by an uniform approach consisting of cytoreductive surgery associated with HIPEC using cisplatin and doxorubicin. The primary end point was overall survival and morbidity rate. The secondary end point was evaluation of prognostic variables for overall survival.
Results:
The median follow-up period was 72 months (range 1-235 months). Thirty-five patients (83.3%) presented epithelial tumors and 7 were affected by multicystic mesothelioma. The mean peritoneal cancer index (PCI) was 13. Thirty-eight patients (90.4%) had complete cytoreduction (CC-0/1). The overall morbidity rate was 35.7% associated to a perioperative mortality of 7.1%. Median overall survival rate was 65 months with a 1- and 5-year survival rates of 63% and 44%, respectively.
Conclusion:
The treatment of DMPM by CRS+HIPEC in selected patients is a feasible technique that allows to achieve encouraging results in terms of overall survival rate, with an acceptable morbidity rate. Further investigations are needed to clarify the role and the timing of this promising technique.
Insights
Cytoreductive surgery plus hyperthermic intraperitoneal perioperative chemotherapy (CRS+HIPEC) offers a feasible treatment for diffuse malignant peritoneal mesothelioma (DMPM), demonstrating improved survival rates with acceptable morbidity in selected patients.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Oncology
Background:
- Diffuse malignant peritoneal mesothelioma (DMPM) is a rare, aggressive cancer with poor prognosis, often linked to asbestos exposure.
- Current treatment options for DMPM are limited, and its underlying biology requires further investigation.
- Specialized centers report improved outcomes with a novel local-regional treatment approach.
Purpose of the Study:
- To evaluate the survival benefit of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal perioperative chemotherapy (HIPEC) for DMPM.
- To assess the morbidity rate associated with the CRS+HIPEC procedure in DMPM patients.
- To identify prognostic variables influencing overall survival in DMPM patients treated with CRS+HIPEC.
Main Methods:
- A cohort of 42 DMPM patients underwent a standardized CRS+HIPEC procedure using cisplatin and doxorubicin.
- The primary endpoints were overall survival and morbidity.
- Secondary endpoints included the analysis of prognostic factors for overall survival.
Main Results:
- The median follow-up was 72 months. Most patients (83.3%) had epithelial DMPM.
- Complete cytoreduction (CC-0/1) was achieved in 90.4% of patients.
- The overall morbidity rate was 35.7%, with a perioperative mortality of 7.1%. Median overall survival was 65 months (1-year: 63%, 5-year: 44%).
Conclusions:
- CRS+HIPEC is a feasible treatment for selected DMPM patients, yielding encouraging survival rates.
- The procedure demonstrates an acceptable morbidity profile.
- Further research is necessary to define the optimal role and timing of CRS+HIPEC in DMPM management.
