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Comprehensive Approach for Treating Peritoneal Mesothelioma is Described

Cancer Consultants, ID - April 9, 2008

Columbia University researchers have reported that combination resection, intraperitoneal chemotherapy, and whole abdominal radiation therapy is effective for treating malignant peritoneal mesothelioma. The February 2008 issue of the American Journal of Clinical Oncology reported details of this study.

Less than 20% of all cases are peritoneal mesothelioma which is far less than the reported number of pleural mesothelioma cases. There is a 20-30 year latency period for abdominal mesothelioma which is shorter than the latency period for pleural mesothelioma. Due to the relative rarity of peritoneal mesothelioma controlled trials of various treatment options are not available. The most common treatment strategy for peritoneal mesothelioma is multimodal and usually involves surgical debulking which is then followed by systemic and/or intraperitoneal chemotherapy. The role of radiation therapy has not been documented well.

The current study involved researchers treating 27 patients with malignant peritoneal mesothelioma. The reported regimen included surgical debulking followed by four intraperitoneal treatment courses of cisplatin alternated with four intraperitoneal treatment courses of doxorubicin. In addition, four doses of intraperitoneal gamma interferon were and a second laparotomy with resection of residual disease was performed. Intraoperative hyperthermic administration of intraperitoneal mitomycin, and cisplatin was followed by whole abdominal radiation therapy. The researchers reported a median survival rate of 70 months and a 67% three-year survival rate. The authors also reported that seven patients were alive and showed no evidence of disease at a median point of 17 months. The conclusion from this study is that patients with peritoneal mesothelioma respond effectively to intensive multimodality therapy.

Additional Comments: This study involved a relatively large number of patients treated in a consistent manner with relatively good outcomes. The precise contribution of each treatment component is not clear and will probably remain so.