More Peritoneal Mesothelioma Patients Need Surgery

Ask any five peritoneal mesothelioma patients whether they were treated with surgery and the odds are that three of them will say “no.”

That’s unfortunate, say the authors of a recently published study in the journal Annals of Surgical Oncology, who reached the conclusion that more peritoneal mesothelioma patients should probably be treated surgically.

Surgery, they wrote, may afford these patients an opportunity for significantly improved survival.

Late Peritoneal Mesothelioma Diagnosis

The reason so many peritoneal mesothelioma victims are not now offered surgical treatment is that the disease is frequently — but not always — discovered only after it reaches an advanced stage.

Mesothelioma doctors are usually reluctant to order surgery so late in the game, the authors allude.

Perhaps they needn’t be reluctant.

During the later stages of pleural mesothelioma, surgery is often unadvisable because tumors by then have usually spread to other organs and anatomic structures.

But that seldom is the case with peritoneal mesothelioma because the tumors usually stay confined to just the abdominal cavity. Rarely do they spread afield, note the authors.

That means surgery for peritoneal mesothelioma patients could be advisable — and beneficial — in later-stage cases, they hint.

Typically, peritoneal mesothelioma is treated with cisplatin- and pemetrexed-based chemotherapy, and little else.

According to the authors, this form of chemotherapy against peritoneal mesothelioma is usually a bust. Or, expressed in more scientific terminology, tumor-response rates are poor and patients show negligible improvement in overall survival.

As an aside, cisplatin- and pemetrexed-based chemotherapy works much better when used to treat pleural mesothelioma, the authors said.

The surgery used in treating peritoneal mesothelioma is called cytoreductive surgery.

Many mesothelioma physicians who perform cytoreductive surgery combine it with hyperthermic intraperitoneal chemoperfusion, which entails administering heated chemotherapy.

The authors report that this combination has not been subjected to well-designed, randomized studies to gauge its true usefulness.

But they said they found evidence from preliminary studies conducted by others that point to overall survival rates of 34 to 92 months. That compares to survival rates of 6 to 12 months without surgery, the authors wrote.

Nonspecific Peritoneal Mesothelioma Symptoms

Part of the explanation for why peritoneal mesothelioma is often diagnosed when it is far along has to do with the fact that the symptoms tend to be nonspecific, the authors wrote.

These symptoms include stomach pain, bloating around the abdomen and weight loss. They could signal many conditions other than mesothelioma, the authors explained.

By the authors’ tally, as many as 400 Americans each year become afflicted with peritoneal mesothelioma.

The authors wrote that they based their observations about peritoneal mesothelioma care on an analysis of data contained in the national Surveillance, Epidemiology, and End Results cancer registry.

They indicated that they used the registry to identify all patients diagnosed with malignant peritoneal mesothelioma, starting in 1973 and extending to 2010.

This gave them a cohort of nearly 1,600 peritoneal mesothelioma patients from which to work.
The patients ranged in age from 53 to 74. More than 60 percent were diagnosed when the disease was well advanced. Those who did not receive surgery totaled 61.6 percent, the writers calculated.

The study authors were doctors from the Medical College of Wisconsin. They offered their views about peritoneal mesothelioma surgery as part of a larger look at current trends in the management of that disease.