Article

A systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma

Washington Hospital Center, Washington, Washington, D.C., United States
Annals of Oncology (Impact Factor: 6.58). 06/2007; 18(5):827-34. DOI: 10.1093/annonc/mdl428
Source: PubMed

ABSTRACT In the past, diffuse malignant peritoneal mesothelioma (DMPM) was regarded as a preterminal condition. The length of survival was dependent upon the aggressive versus indolent biologic behavior of the neoplasm. The overall median survival was approximately 1 year after systemic chemotherapy. Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has been used as a treatment alternative, but the efficacy of this combined treatment remains to be established.
Searches for relevant studies published in peer-reviewed medical journals on CRS and PIC for DMPM before May 2006 were carried out on six databases. The reference lists of all retrieved articles were reviewed for further identification of potentially relevant studies. Expert academic surgeons in Washington, DC, USA were asked whether they knew about any important unpublished data. Two investigators independently evaluated each study according to predefined criteria. The quality of each study was assessed. Clinical effectiveness was synthesized through a narrative review with full tabulation of results of all included studies.
Seven prospective observational studies from six tertiary institutions were available, allowing 240 DMPM patients for assessment. The median survival ranged from 34-92 months. The 1-, 3- and 5-year survival varied from 60% to 88%, 43% to 65% and 29% to 59%, respectively. The perioperative morbidity varied from 25% to 40% and mortality ranged from 0% to 8%.
This systematic review evaluated the current evidence for CRS and PIC for DMPM. Seven observational studies were available for assessment, which demonstrated an improved overall survival, as compared to historical controls, using systemic chemotherapy and palliative surgery.

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    • "However, there is a trend towards aggressive cytoreductive surgery and perioperative intraperitoneal chemotherapy with studies reported a better overall survival (up to 7 years), progression-free survival and near complete palliation of symptomatic ascites in centers performing aggressive surgical debulking followed by hyperthermic intraperitoneal chemotherapy with cisplatin [9] [10] [11]. The rationale behind the hyperthermic intraperitoneal chemotherapy is to deliver high concentrations of cytotoxic agents and hyperthermia directly to the peritoneal tumor, limiting systemic exposure and toxicity [12]. "
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    • "Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is now a common treatment for pseudomyxoma peritonei (PMP), malignant mesothelioma, peritoneal carcinomatosis (PC) from colorectal cancer (CRC) and appendiceal carcinoma, currently supported by survival, morbidity and mortality data [1] [2] [3] [4] [5]. "
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    • "Surgery is the first choice treatment for localized tumors; however, recurrence occurs a few months after surgery and long-term survival is rarely achieved [5]. Particularly for localized tumors, patients with positive lymph node metastasis are believed to have a poor prognosis despite tumor resection [9]. In addition, most malignant peritoneal mesotheliomas are diffuse and difficult to resect, and therefore, in most cases, the treatment consists mainly of chemotherapy [10]. "
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