title: Diffuse malignant peritoneal mesothelioma: Evaluation of systemic chemotherapy with comprehensive treatment through the RENAPE Database: Multi-Institutional Retrospective Study.
abstract: Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network.
  
  
  
  From 1991 to 2014, 126 DMPM patients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC).
  
  
  
  All groups (NA: n = 42; ADJ: n = 16; PO: n = 16; NoC: n = 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P = 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P = 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07-4.94; P = 0.033).
  
  
  
  This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence.
authors.affiliation: Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France.
authors.forename: V
authors.initials: V
authors.lastname: Kepenekian
authors.affiliation: Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Elias
authors.affiliation: Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Passot
authors.affiliation: Department of Pathology, IUCT, Toulouse, France.
authors.forename: E
authors.initials: E
authors.lastname: Mery
authors.affiliation: Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Goere
authors.affiliation: Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France.
authors.forename: D
authors.initials: D
authors.lastname: Delroeux
authors.affiliation: Department of Surgical Oncology, Val d'Aurelle Montpellier Cancer Institute, Montpellier, France.
authors.forename: F
authors.initials: F
authors.lastname: Quenet
authors.affiliation: Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France.
authors.forename: G
authors.initials: G
authors.lastname: Ferron
authors.affiliation: Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
authors.forename: D
authors.initials: D
authors.lastname: Pezet
authors.affiliation: Department of Surgical Oncology, Francois Baclesse Comprehensive Cancer Center, Caen, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Guilloit
authors.affiliation: Department of Surgery, Léon Bérard Comprehensive Cancer Center, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Meeus
authors.affiliation: Surgical Oncologic & Digestive Unit, Lariboisière University Hospital, INSERM, U 965, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Pocard
authors.affiliation: Department of General Surgery and Gastrointestinal Oncology, Archet 2 University Hospital, Nice, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Bereder
authors.affiliation: Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France.
authors.forename: K
authors.initials: K
authors.lastname: Abboud
authors.affiliation: Department of Digestive Surgery, Michallon University Hospital, Grenoble, France.
authors.forename: C
authors.initials: C
authors.lastname: Arvieux
authors.affiliation: Department of General Surgery, Hautepierre University Hospital, Strasbourg, France.
authors.forename: C
authors.initials: C
authors.lastname: Brigand
authors.affiliation: Department of Surgical Oncology, Lorraine Institute of Oncology, Vandoeuvre-les-Nancy, France.
authors.forename: F
authors.initials: F
authors.lastname: Marchal
authors.affiliation: Department of Surgical Oncology, René Gauducheau Integrated Center of Oncology, Nantes, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Classe
authors.affiliation: Department of Surgical Oncology, Paul Papin Integrated Center of Oncology, Angers, France.
authors.forename: G
authors.initials: G
authors.lastname: Lorimier
authors.affiliation: Department of Surgical Oncology, Paoli-Calmettes Institute, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: De Chaisemartin
authors.affiliation: Department of Surgical Oncology, Bergonie Institute, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Guyon
authors.affiliation: Department of Surgical Oncology, Curie Institute, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Mariani
authors.affiliation: Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France.
authors.forename: P
authors.initials: P
authors.lastname: Ortega-Deballon
authors.affiliation: Department of Pathology, Lyon-Sud University Hospital, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Isaac
authors.affiliation: Clinical Research Unit, Pôle IMER (Information Médicale Evaluation et Recherche), Hospices Civils de Lyon, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Maurice
authors.affiliation: Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France.
authors.forename: F N
authors.initials: FN
authors.lastname: Gilly
authors.affiliation: Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France. Electronic address: olivier.glehen@chu-lyon.fr.
authors.forename: O
authors.initials: O
authors.lastname: Glehen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D065426:Cytoreduction Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007274:Injections, Intraperitoneal; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
keywords: Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Peritoneal mesothelioma; Systemic chemotherapy