Mesothelioma Cancer Chemotherapy

Mesothelioma Cancer Chemotherapy

Mesothelioma is a rare but aggressive malignancy. While most pres-ENT cases are in the pleural cavity, malignant peritoneal mesothelioma (MPM) accounts for about 30% of all mesotheliomas with a US annual incidence of only 300 - 500 cases (Yan et al. 2007).

Untreated Mesothelioma has a very poor prognosis and a life expectancy of between 4 and 12 months. Although there have been many advances in chemotherapy, the use of IV systemic chemotherapy provides only modest survival benefits, ranging between 7 and 13 months. 

However, with the success of CRS / HIPEC in various peritoneal malignancies, researchers beginning in the 1980s began utilizing CRS/HIPEC in the management of MPM with significant improvements in overall survival rates ranging from 34 to 100 months (Helm et al. 2015). 

Currently, CRS / HIPEC is the primary treatment for patients with optimally operable and histologically appropriate diseases and provides a significant survival benefit compared to other treatment modalities.

CRS is effective because it leads to locoregional control of the disease in the peritoneal and surface cavities. For patients who may be candidates for this procedure, it is important to exclude patients with hematogenous metastases outside the abdominal compartment. 


All patients require extensive radiological testing using computed tomography (CT) of the chest, abdomen, and pelvis with contrast and the whole body with f-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT.

This imaging evaluates the chest for pleural disease, chest and abdomen for nodal disease, and liver metastases. After the extra-abdominal disease has been removed, a qualitative and quantitative assessment of the tumor load is required and will determine the degree of resection necessary to achieve complete cytoreduction. Tools for determining the burden of the peritoneal disease again are CT and magnetic resonance imaging (MRI).

CT was the initial imaging modality used when patients were diagnosed with PC because of its availability, Ease of Use, and cost. The most common findings on CT imaging include greater omentum involvement seen as reticular retraction, nodular appearance, and sometimes large plaques, and in some cases, diffuse omentum involved and appearing as a large heterogeneous density referred to as "omental caking."

In addition, we usually see focal or diffuse thickening of the peritoneal folds, or large tumor deposits depending on the underlying pathology. There are limitations to imaging, and small tumor deposits (<5 mm) are difficult to appreciate unless deposited on the surface of the liver or spleen. 

Finally, ascites (abdominal fluid) are a common radiographic finding. This can be seen as free intraabdominal ascites or the localized collection and can be easily identified on CT if 50 ml of fluid is present.

Source

Harvey I. Pass, Nicholas Vogelzang, Michele Carbone - Malignant Mesothelioma_ Pathogenesis, Diagnosis, and Translational Therapies-Springer (2005)

Mary Hesdorffer, Gleneara E. Bates-Pappas - Caring for Patients with Mesothelioma_ Principles and Guidelines-Springer International Publishing (2019)

Bruce W S Robinson, A Philippe Chahinian - Mesothelioma (2002).

Alexander HR Jr, et al. Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma. Surgery. 2013;153(6):779-86.

Armstrong DK, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354(1):34^13.

Chua TC, Yan TD, Morris DL. Outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma: the Australian experience. J Surg Oncol. 2009;99(2): 109-13.


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