Mesothelioma Survival Is Longer with Combo of Surgery and Chemotherapy

The best strategy for treating diffuse malignant peritoneal mesothelioma is a combination of cytoreductive surgery and HIPEC (hyperthermic intraperitoneal chemotherapy).

That’s what French researchers writing in the European Journal of Cancer believe after examining 23 years worth of medical records from patients with diffuse malignant peritoneal mesothelioma.

You should therefore feel more confident about cytoreductive surgery with HIPEC if you have peritoneal mesothelioma and are considering this paired procedure.

However, you may want to think carefully about having neoadjuvant chemotherapy prior to cytoreductive surgery and HIPEC. According to the researchers, it can reduce survival potential.

The researchers noted that the combination of cytoreductive surgery and HIPEC is the acknowledged gold standard for waging war against diffuse malignant peritoneal mesothelioma.

Therefore, peritoneal mesothelioma patients would be wise to choose cytoreductive surgery and HIPEC as the first line of treatment (if their doctors deem it appropriate), the researchers contend.

Cytoreductive Surgery and HIPEC Best Treatment for Peritoneal Mesothelioma

Cytoreductive surgery is a procedure that has as its goal the elimination of all mesothelioma cells in the abdomen and pelvic region. This is accomplished with the use of multiple peritonectomy procedures.

HIPEC comes immediately after the surgery and while you’re still on the operating table. It entails administering heated chemotherapy drugs. Typically, the drugs used are cisplatin and doxorubicin.

The value of doxorubicin is that it discourages mesothelioma cells from coming back. It does this by inhibiting the enzyme topoisomerase II and by promoting DNA-destroying free radicals to form.

The HIPEC drugs are delivered using an intraperitoneal approach. This helps concentrate them in the vicinity of the now-removed mesothelioma to make sure that area is fully purged of cancer.

The intraperitoneal delivery of the chemo drugs also serves to keep toxicity confined locally. Since the toxicity isn’t systemic (as it would be with standard chemo), you have fewer and less severe side effects.

In earlier studies, other researchers found that cytoreductive surgery plus HIPEC could stretch overall survival with diffuse malignant peritoneal mesothelioma to at least 10 years.

Records Examined from Peritoneal Mesothelioma Patients

The French researchers performed their study by retrieving and reviewing the medical records of 126 diffuse malignant peritoneal mesothelioma patients.

These records were obtained through the French Network for Rare Peritoneal Malignancies. The network is made up of hospitals and clinics located throughout France.

The retrieved records came from 20 of the network’s member facilities. The retrieved records went back as far as 1991. The most recent were from 2014.

The researchers explained that their goal was to understand how well cytoreductive surgery and HIPEC together were or weren’t helping diffuse malignant peritoneal mesothelioma patients survive longer.

The 126 patients were divided into groups based on the type of chemotherapy they received in addition to the cytoreductive surgery with HIPEC treatment.

There was one group of 42 patients who received neoadjuvant chemotherapy. There was another consisting of 16 patients that received adjuvant chemotherapy.

Still another group of 16 consisted of patients who received perioperative chemotherapy. A fourth group received no chemotherapy at all. That last group had 48 patients in it.

The researchers found that the adjuvant chemotherapy group had the best outlook. Sixty-seven percent of them were still alive five years after treatment.

By comparison, only 40 percent of the neoadjuvant chemotherapy group had survived five years after treatment.

The perioperative chemotherapy group did almost as well as the adjuvant chemotherapy group. Sixty-two percent of its members remained alive at the end of five years.

In third place was the no-chemotherapy group. Still alive at the end of five years were 56 percent of that group’s patients.

The title of the researcher’s study is “Diffuse Malignant Peritoneal Mesothelioma: Evaluation of Systemic Chemotherapy with Comprehensive Treatment Through the RENAPE Database.”