title: Treatment of diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery and HIPEC.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Unit of Surgical Oncology, IRCCS (Scientific Institute for Cancer Research and Treatment), Candiolo, Turin, Italy - manuela.robella@hotmail.it.
authors.forename: M
authors.initials: M
authors.lastname: Robella
authors.forename: M
authors.initials: M
authors.lastname: Vaira
authors.forename: A
authors.initials: A
authors.lastname: Mellano
authors.forename: P
authors.initials: P
authors.lastname: Marsanic
authors.forename: A
authors.initials: A
authors.lastname: Cinquegrana
authors.forename: A
authors.initials: A
authors.lastname: Borsano
authors.forename: M
authors.initials: M
authors.lastname: Barbera
authors.forename: A
authors.initials: A
authors.lastname: Caneparo
authors.forename: D
authors.initials: D
authors.lastname: Siatis
authors.forename: A
authors.initials: A
authors.lastname: Sottile
authors.forename: M
authors.initials: M
authors.lastname: De Simone
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D053208:Kaplan-Meier Estimate; D019394:Ki-67 Antigen / Q000032:analysis; D010535:Laparoscopy; D007813:Laparotomy; D008175:Lung Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008654:Mesothelioma / Q000737:chemistry / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D011300:Preoperative Care; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; D004317:Doxorubicin; D002945:Cisplatin