Multicystic and Well-differentiated Papillary Peritoneal Mesothelioma Treated by Surgical Cytoreduction and Hyperthermic Intra-peritoneal Chemotherapy (HIPEC)
Department of Surgery, National Cancer Institute, Milan, Italy. Annals of Surgical Oncology
(Impact Factor: 3.93).
10/2007; 14(10):2790-7. DOI: 10.1245/s10434-007-9475-8
Multicystic peritoneal mesothelioma (MPM) and well-differentiated papillary peritoneal mesothelioma (WDPPM) are exceedingly uncommon lesions with uncertain malignant potential and no uniform treatment strategy. The aim of the current study was to review our experience with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in these clinical settings.
Four women with MPM and eight with WDPPM underwent 13 procedures of cytoreduction and close-abdomen HIPEC with cis-platin and doxorubicin. Seven patients had recurrent disease after previous debulking (one operation in five patients, two in one, four in one). Potential clinicopathological prognostic factors were assessed.
Optimal cytoreduction (residual tumor nodules <or=2.5 mm) was performed in 12 of 13 procedures. Median follow-up was 27 months (range 6-94). One grade 4 postoperative complication (NCI/CTCAE v.3.0) and no operative mortalities occurred. One patient underwent the procedure twice due to locoregional MPM recurrence. Transition of typical WDPPM to malignant biphasic mesothelioma was documented in one patient who died of disease progression following incomplete cytoreduction and HIPEC. Following multimodality treatment, 5-year overall and progression-free survival were 90.0% (standard error = 9.0) and 79.7% (11.9), respectively. Progression-free survival following previous debulking surgery (median 24 months; range 2-87) was statistically worse (P = .0156). Incomplete cytoreduction and poor performance status correlated to both reduced overall and progression-free survival after cytoreduction and HIPEC.
MPM and WDPPM are borderline tumors capable of transformation into potentially lethal processes. Definitive tumor eradication by means of cytoreduction and HIPEC seems more effective than debulking surgery in preventing disease recurrence or transition to aggressive malignancies.
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- "HIPEC was offered to the patient as the next line of treatment due to its support in the literature, with potentially longer disease free survival and less transformation of WDPM into malignant processes after treatment with HIPEC. Baratti et al. (2007) reported that cytoreduction and HIPEC with cisplatin and doxorubicin seem more effective than debulking surgery in preventing disease recurrence or transition or WDPM to aggressive malignancy. Information regarding progression and prognosis of WDPM are lacking in the literature. "
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► We present a case of endometrioid ovarian cancer with concomitant well differentiated papillary mesothelioma of the peritoneum. ► Endometrioid ovarian cancer with concomitant well differentiated papillary mesothelioma is an extremely rare surgical finding of uncertain prognostic significance. ► Treatment with carboplatin and gemcitabine was given with no evidence of disease six months after diagnosis.
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Available from: Wenceslao Vásquez Jiménez
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ABSTRACT: La Enfermedad Peritoneal Maligna (EPM), se define cómo el crecimiento de tejido neoplásico en el peritoneo, ya sea originado de forma, primario, en el mismo peritoneo (mesotelioma, adenocarcinoma primario peritoneal) ó secundario a la diseminación de tumores digestivos o ginecológicos ó invasión de sarcomas. Los objetivos principales de este estudio son tres. En primer lugar, determinar la supervivencia global y libre de enfermedad en pacientes con Enfermedad Peritoneal Maligna, tratados con Citoreducción máxima y quimioterapia perioperatoria. En segundo lugar, estimar la morbilidad y mortalidad asociada a los procedimientos de Citoreducción y quimioterapia perioperatoria. Y por último, establecer factores pronósticos asociados a mortalidad y a complicaciones mayores, de los procedimientos de Citoreducción y quimioterapia intraperitoneal perioperatoria.
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