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Multimodality Peritoneal Mesothelioma Treatment

A very successful strategy for treating peritoneal mesothelioma has emerged that combines aggressive debulking of the tumor with one or more of the other techniques as adjuvants. This is considered to be a local technique for irradiating disease. For patients who have distant metastatic disease, surgical resection in most cases is not an option. In the rare case where control of disease can be demonstrated over time, multimodality peritoneal mesothelioma surgery can be reconsidered in patients who have presented with dual compartment disease (chest and abdomen). To date this treatment option has not proved successful in sarcomatoid disease so these patients are usually referred on to systemic treatment. Those demonstrating a good response will be reconsidered for surgery.

Success of Multimodality Peritoneal Mesothelioma Surgery

Several treatment centers now offer peritoneal mesothelioma treatment that involves several courses of surgery over a specific interval, with chemotherapy, radiation or other treatments either during or after the surgeries. Success with this approach has been excellent and there are now a number of long term 7+ year survivors of peritoneal mesothelioma as proof of the value of this multimodality approach.

Though similar in ways, this peritoneal mesothelioma surgery is quite different from the debulking surgery approved for use in ovarian cancer. The doses and types of chemotherapy agents differ as do the resulting morbidity and mortality from surgery. This surgery should only be considered if a patient is under the care of an experienced mesothelioma surgeon.

Relapse patterns have been studied and interesting data has been reported that genetic mutations can also play a role in predicting poor survival and relapse in patients undergoing surgery and intraperitoneal mesothelioma. In time, this will assist in determining who should be referred to surgical treatment or perhaps therapies will be developed to target these mutations prior to undergoing surgery. This is a major breakthrough in understanding the natural history of this disease.

The technique of using heated chemoperfusion to attack the residual mesothelioma tumor in the abdominal space was pioneered by the peritoneal surgeons and was then applied to the pleural mesothelioma environment where the strategy is under investigation by several institutions.

Searching for more Resources on peritoneal mesothelioma surgery? Browse the list of resources below:

Diffuse malignant peritoneal mesothelioma: Failure analysis following cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC).

Novel and existing mutations in the tyrosine kinase domain of the epidermal growth factor receptor are predictors of optimal resectability in malignant peritoneal mesothelioma.

Morbidity and mortality assessment of cytoreductive surgery and perioperative intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma--a prospective study of 70 consecutive cases.

Clinical results of cytoreduction and HIPEC for malignant peritoneal mesothelioma.Alexander HR, Hanna N, Pingpank JF.

Combined resection, intraperitoneal chemotherapy, and whole abdominal radiation for the treatment of malignant peritoneal mesothelioma.