Malignant peritoneal mesothelioma: treatment with maximal cytoreductive surgery plus intraperitoneal chemotherapy.
OBJECTIVE
To report survival results in patients with diffuse malignant peritoneal mesothelioma (MPM) treated with maximal cytoreductive surgery followed by immediate intraperitoneal chemotherapy, and to compare them with the median survival of 12-24 months obtained with the standard treatment based on systemic chemotherapy.


METHODS
Twenty-six patients underwent this new regional approach and a median follow-up of 55 months was achieved after this treatment. Complete cytoreductive surgery (residual disease < 2 mm) was performed in all but one patient. Intraperitoneal chemotherapy was performed with hyperthermia (4245 degrees C) and oxaliplatin in 22 patients. The last 12 patients additionally received irinotecan. Data were prospectively verified and retrospectively analyzed.


RESULTS
One patient died postoperatively (4%), and morbidity attained 54%. The median survival exceeded 100 months and the overall 5-year survival rate was 63%. This small series lacks the statistical power required to conduct a well-grounded study on prognostic factors, particularly as the completeness of the surgery is not analyzable here. However, the low-grade histological types had a better disease-free survival rate that was of borderline significance compared to their high-grade counterparts.


CONCLUSIONS
This new approach combining complete cytoreductive surgery considerably increases the survival of patients with MPM compared with the standard treatment based on systemic chemotherapy.
Elias
Dominique
D
Département de chirurgie générale oncologique, Institut Gustave-Roussy, 39 rue Camille-Desmoulins, Villejuif Cedex.
Bedard
Valérie
V
Bouzid
Tarek
T
Duvillard
Pierre
P
Kohneh-Sharhi
Niaz
N
Raynard
Bruno
B
Goere
Diane
D
D000970:Antineoplastic Agents / Q000627:therapeutic use; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D006979:Hyperthermia, Induced; D000077146:Irinotecan; D008297:Male; D008654:Mesothelioma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D011355:Prodrugs / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D011355:Prodrugs; D000077150:Oxaliplatin; D000077146:Irinotecan; D002945:Cisplatin; D002166:Camptothecin