Diffuse malignant peritoneal mesothelioma: Evaluation of systemic chemotherapy with comprehensive treatment through...

Area of Science:

• Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Diffuse malignant peritoneal mesothelioma (DMPM) is a rare cancer with limited treatment options.
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) offers the longest survival for DMPM.
• The role of perioperative chemotherapy in conjunction with CRS-HIPEC for DMPM is not fully elucidated.

Purpose of the Study:

• To evaluate the impact of different perioperative systemic chemotherapy strategies on survival and postoperative outcomes.
• To analyze data from a multi-institutional database (French RENAPE network) of DMPM patients treated with curative intent CRS-HIPEC.

Main Methods:

• Retrospective analysis of 126 DMPM patients from 1991 to 2014.
• Patients were categorized into four groups: neoadjuvant chemotherapy (NA), adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO), and no chemotherapy (NoC).
• Comparison of clinicopathological data, overall survival (OS), and major postoperative complications across the groups.

Main Results:

• The 5-year OS rates were 40% (NA), 67% (ADJ), 62% (PO), and 56% (NoC) (P=0.049).
• Neoadjuvant chemotherapy (NA) was independently associated with worse OS (HR, 2.30; P=0.033).
• Major complication rates were comparable across all groups (41-45%).

Conclusions:

• Adjuvant chemotherapy may delay recurrence and improve survival in DMPM patients treated with CRS-HIPEC.
• Neoadjuvant chemotherapy prior to CRS-HIPEC may negatively impact survival.
• Upfront CRS and HIPEC should be considered when feasible, pending further evidence.