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Peritoneal mesothelioma treated by induction chemotherapy, cytoreductive surgery, and intraperitoneal hyperthermic perfusion
Author(s) -
Deraco Marcello,
Casali Paolo,
Inglese M.G.,
Baratti Dario,
Pennacchioli Elisabetta,
Bertulli Rossella,
Kusamura Shigeki
Publication year - 2003
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.10255
Subject(s) - medicine , mesothelioma , peritoneal mesothelioma , ascites , surgery , hyperthermic intraperitoneal chemotherapy , chemotherapy , cisplatin , hyperthermia , prospective cohort study , cytoreductive surgery , cancer , ovarian cancer , pathology
Background and Objectives Peritoneal mesothelioma (PM) is a rare disease, with a poor prognosis. We decided to prospectively evaluate the prognostic impact of aggressive surgery followed by intraperitoneal chemotherapy with local hyperthermia. Patients and Methods In this prospective study, 19 patients with PM were treated by cytoreductive surgery (CRS) and intraperitoneal hyperthermic perfusion (IPHP). Mean follow‐up was 27 months (range: 1–65). Fifteen (68%) patients had malignant disease, two had well‐differentiated papillary mesothelioma, and two had multicystic PM. Thirteen (65%) patients received preoperative chemotherapy. Fifteen cases (75%) underwent optimal cytoreduction (residual disease <2.5 mm). One patient underwent the procedure twice due to locoregional progression. IPHP was performed with closed abdomen technique, using a preheated polysaline perfusate (42.5°C) containing cisplatin + mitomycin C or cisplatin + doxorubicin administered through a heart–lung pump for 60 or 90 min. Results Three‐year overall and progression‐free survival was 69 and 66%, respectively. The operative morbidity (grade II/III), mortality, and overall toxicity (grade I–IV) rates were 25, 0, and 30%, respectively. Seventeen (94%) out of 18 patients had resolution of ascites. Conclusions This therapeutic strategy proved feasible and was well tolerated. Early results seem promising and consistent with a potentially major impact on survival in selected patients with PM. J. Surg. Oncol. 2003;83:147–153. © 2003 Wiley‐Liss, Inc.