Management of Malignant Peritoneal Mesothelioma Using Cytoreductive Surgery and Perioperative Chemotherapy

2016 ◽  
Vol 12 (10) ◽  
pp. 928-935 ◽  
Author(s):  
Paul H. Sugarbaker ◽  
Kiran K. Turaga ◽  
H. Richard Alexander ◽  
Marcello Deraco ◽  
Mary Hesdorffer
Keyword(s):  
Cytoreductive Surgery ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
The United States ◽  
Management Plan ◽  
Peritoneal Mesothelioma ◽  
Perioperative Chemotherapy ◽  
Malignant Peritoneal Mesothelioma ◽  
Peritoneal Space

Malignant peritoneal mesothelioma is a rare disease, with approximately 800 new patients per year in the United States. Its natural history is defined by progression restricted to the peritoneal space. In the past, patients with this disease had a limited lifespan of approximately 1 year. Numerous single-institution studies as well as a systematic review have reported median survival of 3 to 5 years with a combination of cytoreductive surgery and hyperthermic perioperative chemotherapy. These markedly improved survival statistics were achieved in experienced centers with 1% mortality and 20% morbidity rates. Data have shown that knowledgeable patient selection is required to prevent patients unlikely to benefit from undergoing these interventions. The conclusion is that patients with peritoneal mesothelioma can experience long-term progression-free survival or significant palliation with cytoreductive surgery plus hyperthermic perioperative chemotherapy. This management plan should be considered the standard of care for properly selected patients with malignant peritoneal mesothelioma at experienced centers around the world.

Two Decades of Progress in the Management of a Rare Disease—Peritoneal Mesothelioma

2015 ◽  
Vol 11 (01) ◽  
pp. 67
Author(s):  
Paul H ugarbaker ◽  
Keyword(s):  
Cytoreductive Surgery ◽  
Systemic Chemotherapy ◽  
Treatment Options ◽  
Management Plan ◽  
Regional Chemotherapy ◽  
Peritoneal Mesothelioma ◽  
Perioperative Chemotherapy ◽  
Term Survival ◽  
Peritoneal Space

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare but aggressive disease with a poor sustained response to systemic chemotherapy. Historically, the median survival has been less than 1 year. The disease rarely disseminates outside of the peritoneal space suggesting that local-regional treatment options may be effective in the long-term control of this malignancy. Establishment of a referral center to concentrate experience with the management of this disease has contributed greatly to progress in its management.Materials and methods:Through a series of Institutional Review Board-approved protocols, a long-standing morbidity/mortality assessment, numerous manuscripts published in the peer-reviewed literature, and participation in numerous national and international workshops, a new standard of care with expectations of long-term survival in a majority of patients has evolved.Results:The surgery for this disease has evolved through a sequence of peritonectomy procedures and visceral resections whose goal is to remove all visible evidence of disease. The first step in successful treatment is a complete cytoreduction. After the cancer resection in the operating room, hyperthermic perioperative chemotherapy (HIPEC) is used. A three-drug protocol combines heat-augmented chemotherapy within the peritoneal space and systemic chemotherapy that is heat-augmented as a continuous infusion intravenously. Catheters are placed for early postoperative intraperitoneal chemotherapy using paclitaxel for 5 days. Also placed at the time of the cytoreductive surgery is an intraperitoneal port for long-term combined intraperitoneal and systemic chemotherapy using cisplatin and pemetrexed for 6 months. Patients having the long-term bidirectional chemotherapy have shown statistically significant improved survival compared with those patients who had surgery alone plus the perioperative chemotherapy. There have been no mortality and the grade 4 adverse events have been prospectively accumulated as 12 %.Conclusions:With continued effort, the surgery and long-term regional chemotherapy for DMPM has continued to improve over 20 years. Currently, a management plan that involves cytoreductive surgery, perioperative chemotherapy, and long-term bidirectional chemotherapy has changed the natural history of this disease. A global registry has been initiated to confirm the benefits of these extended treatments.

scholarly journals Cytoreductive Surgery Plus Hyperthermic Perioperative Chemotherapy for Selected Patients with Peritoneal Metastases from Colorectal Cancer: A New Standard of Care or an Experimental Approach?

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Paul H. Sugarbaker
Keyword(s):  
Colorectal Cancer ◽  
Cytoreductive Surgery ◽  
Standard Of Care ◽  
Peritoneal Metastases ◽  
Perioperative Chemotherapy ◽  
Term Survival ◽  
Results Of Treatment ◽  
Crs And Hipec ◽  
One Year

Peritoneal metastases (PM) are a common presentation for patients with metastatic colorectal cancer (CRC), and the median survival of patients with PM is approximately one year. In a majority of patients, the disease remains limited to the peritoneal cavity. Therefore, investigators have applied cytoreductive surgery (CRS) and heated perioperative chemotherapy (HIPEC) as a standard approach for selected patients with PM from CRC. These investigators have demonstrated a very promising long-term survival in a subset of patients with a limited amount of isolated peritoneal metastatic disease. This paper presents the data that supports CRS and HIPEC as a treatment option for CRC patients with PM. These results of treatment are compared and contrasted to the results that can be expected with systemic chemotherapy alone.

scholarly journals A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma

2017 ◽  
Vol 44 (5) ◽  
pp. 530-544 ◽  
Author(s):  
Thales Paulo Batista ◽  
Bruno José Queiroz Sarmento ◽  
Janina Ferreira Loureiro ◽  
Andrea Petruzziello ◽  
Ademar Lopes ◽  
...  
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Standard Of Care ◽  
Surgical Oncology ◽  
Peritoneal Mesothelioma ◽  
Comprehensive Treatment ◽  
Special Focus ◽  
Malignant Peritoneal Mesothelioma ◽  
Brazilian Society ◽  
Peritoneal Surface Malignancies

ABSTRACT Cytoreductive surgery plus hypertermic intraperitoneal chemotherapy has emerged as a major comprehensive treatment of peritoneal malignancies and is currently the standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome as well as malignant peritoneal mesothelioma. Unfortunately, there are some worldwide variations of the cytoreductive surgery and hypertermic intraperitoneal chemotherapy techniques since no single technique has so far demonstrated its superiority over the others. Therefore, standardization of practices might enhance better comparisons between outcomes. In these settings, the Brazilian Society of Surgical Oncology considered it important to present a proposal for standardizing cytoreductive surgery plus hypertermic intraperitoneal chemotherapy procedures in Brazil, with a special focus on producing homogeneous data for the developing Brazilian register for peritoneal surface malignancies.

scholarly journals Long-term efficacy of imatinib mesylate in patients with advanced Tenosynovial Giant Cell Tumor

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
F. G. M. Verspoor ◽  
M. J. L. Mastboom ◽  
G. Hannink ◽  
R. G. Maki ◽  
A. Wagner ◽  
...  
Keyword(s):  
Giant Cell ◽  
Imatinib Mesylate ◽  
Locally Advanced ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Complete Response ◽  
The United States ◽  
Long Term Effects ◽  
Giant Cell Tumors

Abstract Tenosynovial giant cell tumors (TGCT), are rare colony stimulating factor-1(CSF-1)-driven proliferative disorders affecting joints. Diffuse-type TGCT often causes significant morbidity due to local recurrences necessitating multiple surgeries. Imatinib mesylate (IM) blocks the CSF-1 receptor. This study investigated the long term effects of IM in TGCT. We conducted an international multi-institutional retrospective study to assess the activity of IM: data was collected anonymously from individual patients with locally advanced, recurrent or metastatic TGCT. Sixty-two patients from 12 institutions across Europe, Australia and the United States were identified. Four patients with metastatic TGCT progressed rapidly on IM and were excluded for further analyses. Seventeen of 58 evaluable patients achieved complete response (CR) or partial response (PR). One- and five-year progression-free survival rates were 71% and 48%, respectively. Thirty-eight (66%) patients discontinued IM after a median of 7 (range 1–80) months. Reported adverse events in 45 (78%) patients were among other edema (48%) and fatigue (50%), mostly grade 1–2 (89%). Five patients experienced grade 3–4 toxicities. This study confirms, with additional follow-up, the efficacy of IM in TGCT. In responding cases we confirmed prolonged IM activity on TGCT symptoms even after discontinuation, but with high rates of treatment interruption and additional treatments.

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