Peritoneal Mesothelioma Treatment

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This page is to inform you of the different types of Peritoneal Mesothelioma Treatments that are currently available.

It is important to note that the prognosis for malignant peritoneal mesothelioma still remains disappointing.  However, there have been a few improvements in prognosis from recent chemotherapies and treatments.

Things to Note:

1.  Malignant mesothelioma treated during the early stages have a better prognosis, however cures are very rare.

2.  The malignancy is also affected by  factors such as the continuous mesothelial surface of the pleural cavity, invasion to underlying tissue and other organs within the pleural cavity, and the very long latency period between asbestos exposure and actual development of the disease.

3.  The histological subtype, patient’s age, and health also help predict prognosis.

4.  Treatment and survival through Epithelioid histology responds better to treatment than sarcomatoid histology.

Below are the most common type of Peritoneal Mesothelioma Treatment:

Surgery

–  Surgery, alone, is very disappointing.  It is common to expect a survival with surgery of only around 12 months.

–  Surgery combined with radiation and chemotherapy has a greater expectancy.

–  A pleurectomy/decortication is the most common surgery.  Here, the lining of the chest is removed.

–  Extrapleural pneumonectomy (EPP) surgery is not performed as much and consists of the removal of the lung, lining of the inside of the chest, the hemi-diaphragm, and the pericardium are removed.

Radiation

–  Radiation is often given for those with a localized disease and is given post-op as a consolidative treatment.

–  The hemi-thorax is treated with radiation therapy, often in conjunction with chemotherapy.

–  Radiation combined with chemotherapy after a radical surgery has actually increased life expectancy in certain patient populations as much as  5 years.

–  To halt the growth of the tumor along the interior chest wall, radiotherapy is applied to chest drain insertion sites

Chemotherapy

–  Chemotherapy is proven as the only treatment for peritoneal mesothelioma to improve survival in random and controlled trials.

–  In a study published in 2003 a trial reported a survival advantage from chemotherapy in malignant pleural mesothelioma.  It showed a large improvement in survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the different group who were treated with cisplatin in the combination with pemetrexed who also received supplements with folate and vitamin B12.

–  In February 2004, the USFDA approved pemetrexed for malignant pleural mesothelioma treatment.  Questions still remain as to the best use of chemotherapy, such as when to start treatment and the best number of cycles to give.

–  When combined with Cisplatin, Raltitrexed shows improvement in survival close to that reported for pemetrexed in combination with cisplatin.

–  Cisplatin when combined with gemcitabine or vinorelbine can be an alternative, or vinorelbine solely for patients who cannot tolerate pemetrexedal.

–  Carboplatin can be used for those for whom cisplatin cannot be used.

–  In January 2009, the USFDA approved therapies such as surgery in conjunction with radiation and or chemotherapy on stage I or II Mesothelioma.  This was in major part due to research performed Duke University that conducted a nationwide study that concluded an significant 50 point increase in remission rates.

Immunotherapy

–  Variable results have been shown for treatments that involve immunotherapy.

–  While trying to increase the immune response, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) turned out to have  no benefit for the patient.

–  Major side effects were experienced for those given in vitro lysis by LAK cells following activation by interleukin-2 (IL-2).

–  Some trials containing interferon alpha actually have been more encouraging as 20% of patients experience a greater than 50% reduction in tumor mass combined with minimal side effects.

Heated Intraoperative Intraperitoneal Chemotherapy

– Developed by Paul Sugarbaker at the Washington Cancer Institute the tumor is removed as much as possible.  This is then  followed by an administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.

–  This allows the administration of high concentrations of select drugs into the abdominal and pelvic surfaces. The drugs penetrate  into the tissues at a greater rate by heating the treatment.  Heating has proven to damage the malignant cells more than the normal cells.

–  This technique can be used by those with malignant pleural mesothelioma.

Multimodality Therapy

– Trimodality therapy which combines surgery, adjuvant chemotherapy, and radiation has provided significant increases in survival. Sometimes upwards of 3–14 years for patients with favorable prognosisi factors.

– Other multimodality treatments  though have only shown a  slight improvement in survival.  Usually between  14.5 months and  2 year).

– Increasing survival with cytoreductive surgery can be accomplished by reducing the bulk of the tumor.

The below operations are highly dependent on the size of the tumor:

– Pleurectomy/decortication is given to patients in the early stages where the intent is to rid of all gross visible tumor.  This helps to spare the lung.

– Extrapleural pneumonectomy is much more extensive. Usually given to those in a more advanced state, it involves resection of the parietal and visceral pleurae, the lung, ipsilateral diaphragm, and the ipsilateral pericardium.

Epidemiology

–  Reported incidence rates have actually been on the rise in the past 20 years, although still relatively rare.

–  Incidence rates varyes from country to country (less than 1 per 1,000,000 per year in Tunisia and Morocco), (highest rate in Britain, Australia and Belgium: 30 per 1,000,000 per year).

–  Incidence seems to have  peaked at 15 per 1,000,000 in 2004 in the United States.

–  Incidence is expected to rise in other parts of the world.

–  Mesothelioma occurs more often in men than in women.

–  Mesothelioma risk increases with age.

–  About one fifth to one third of all mesotheliomas are peritoneal.

–  Occupational exposure to asbestos affected approx. 27.5 million people between 1940 and 1979 in the United States.

–  The incidence of pleural mesothelioma among white males increased 100% between 1973 and 1984.

–  The death rate from mesothelioma in the US increased from 2,000 per year to 3,000 from 1980 to late 1990.

–  Men are four times more likely to obtain it than women.

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