Abdominal computed tomography scans in the selection of patients with malignant peritoneal mesothelioma for comprehensive treatment with cytoreductive surgery and perioperative intraperitoneal chemotherapy.
BACKGROUND
Malignant peritoneal mesothelioma is a rare and fatal disease. Until recently, the treatment options were very limited and ineffective. The new comprehensive approach of cytoreductive surgery with perioperative intraperitoneal chemotherapy offers improved survival rates at a cost of considerable morbidity and mortality as in other peritoneal surface malignancies. The outcome after these treatments is predominantly dependent on adequate cytoreduction. The aim of the current study was to identify computed tomography (CT) scan images that are useful in patient selection for this comprehensive approach.


METHODS
An analysis of the preoperative CT scans of 30 patients with peritoneal mesothelioma treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy at a single institution was performed. Based on the size of residual tumor nodules after cytoreductive surgery, patients were divided into 2 groups: those with residual lesions<or=2.5 cm (adequate cytoreduction) and those with residual lesions>2.5 cm (suboptimal cytoreduction). The CT scans for each patient were evaluated by a standardized scoring system with the reader blinded to the operative findings. Thirty-nine CT scan parameters were obtained and statistically analyzed to determine their association with the study outcome variables, namely, adequacy of cytoreduction.


RESULTS
Seven patients (64%) in the suboptimal cytoreduction group and 2 patients (11%) in the adequate cytoreduction group had a >5-cm tumor mass in the epigastric region (P=0.004). Nine patients (82%) in the suboptimal group and 2 patients (11%) in the adequate cytoreduction group had CT scans that showed loss of normal architecture of the small bowel and its mesentery (P<0.001). In a composite analysis of these 2 radiologic features, none of the patients with a >5-cm tumor mass in the epigastric region and loss of normal architecture of the small bowel and its mesentery had an adequate cytoreduction. Patients who lacked these two preoperative CT scan findings had a 94% probability of an adequate cytoreduction.


CONCLUSIONS
CT scans effectively identified large peritoneal mesothelioma tumors at crucial anatomic sites. Because adequate cytoreduction is necessary to achieve prolonged survival, CT scans became an accurate prognostic radiologic test for patient selection for comprehensive treatment.
Yan
Tristan D
TD
Program in Peritoneal Surface Malignancy, Department of Surgical Oncology, Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010, USA.
Haveric
Namic
N
Carmignani
Carlos P
CP
Chang
David
D
Sugarbaker
Paul H
PH
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging* / Q000628:therapy*; D008875:Middle Aged; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents