title: Therapeutic strategies for well-differentiated papillary mesothelioma of the peritoneum.
abstract: OBJECTIVE
  Well-differentiated papillary mesothelioma is an uncommon subtype of mesothelioma with a frequently indolent course, although it occasionally manifests in a more aggressive form. To establish a treatment strategy for this rare disease, we report the clinical characteristics and outcomes of 15 patients with well-differentiated papillary mesothelioma.
  
  
  METHODS
  All pathologically diagnosed well-differentiated papillary mesothelioma cases were reviewed between 1998 and 2012.
  
  
  RESULTS
  Of the 15 cases, 8 and 7 presented with single and multiple lesions, respectively. All cases with single lesions were asymptomatic, while 4 out of the 7 cases with multiple lesions were symptomatic. After tumor excision, none of the eight single-lesion cases experienced tumor recurrence. Among the other seven cases with multiple lesions, only one patient with disseminated lesions died due to disease burden. Five patients with multiple lesions received cisplatin-based intravenous or intraperitoneal chemotherapy, with a mix of complete (n= 2) and partial (n= 2) responses observed. Of particular note, one patient receiving cisplatin and pemetrexed combination chemotherapy experienced complete tumor resolution without any serious toxicity.
  
  
  CONCLUSIONS
  We recommend different treatment strategies based on the disease status. If the tumor is completely resectable, an excisional biopsy seems to be sufficient. If complete resection is unavailable for the asymptomatic patient with a localized tumor extent, close follow-up is an appropriate option. When the tumor is extensive or accompanied by symptoms, chemotherapy should be strongly considered.
authors: *Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. hyosong77@yuhs.ac.
authors: Young Ki
authors: YK
authors: Lee
authors: Hyun Jung
authors: HJ
authors: Jun
authors: Ji Hae
authors: JH
authors: Nahm
authors: Tae Seop
authors: TS
authors: Lim
authors: Ji Soo
authors: JS
authors: Park
authors: Joong Bae
authors: JB
authors: Ahn
authors: Sun Young
authors: SY
authors: Rha
authors: Hyun Cheol
authors: HC
authors: Chung
authors: Hwa Eun
authors: HE
authors: Oh
authors: Ji-Sun
authors: JS
authors: Song
authors: Woo Ick
authors: WI
authors: Yang
authors: Hyo Song
authors: HS
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis*; D064032:Calbindin 2; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005971:Glutamates / Q000008:administration & dosage; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007150:Immunohistochemistry; D007262:Infusions, Intravenous; D007263:Infusions, Parenteral; D008297:Male; D008654:Mesothelioma / Q000737:chemistry / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy; D000068437:Pemetrexed; D010534:Peritoneal Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D049268:Positron-Emission Tomography; D011379:Prognosis; D012307:Risk Factors; D064030:S100 Calcium Binding Protein G / Q000032:analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D014408:Biomarkers, Tumor; D064032:Calbindin 2; D005971:Glutamates; D064030:S100 Calcium Binding Protein G; C500987:monoclonal antibody D2-40; D000068437:Pemetrexed; D006147:Guanine; D002945:Cisplatin
keywords: chemotherapy; cisplatin; pemetrexed; peritoneum; therapeutic strategy; well-differentiated papillary mesothelioma