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Multimodal Treatment for Mesothelioma Quadruples Life Expectancy

A recent review of multimodal peritoneal mesothelioma treatments found that certain qualified patients who undergo both cyto-reductive surgery, sometimes called CS, and immediate intra-peritoneal chemotherapy may actually be able to more than quadruple the median life expectancy of most diffuse malignant peritoneal mesothelioma sufferers. 

The study completed by researchers from the Melanoma and Sarcoma Unit at the Veneto Institute of Oncology in Padova, Italy and the Department of Oncological and Surgical Sciences at the University of Padova found that while the normal life span of a patient suffering from malignant peritoneal mesothelioma (MPM) is roughly 12.5 months, patients who survive this type of radical and invasive treatment live, on average, 53 months. Indeed, 47% of patients whose cases were reviewed in this study lived up to the five-year mark—a milestone in mesothelioma survival.

One common mesothelioma treatment is cyto-reductive surgery, an invasive technique in which tumors are physically removed either entirely or partially, and then undergo follow-up systematic chemotherapy. Sometimes the process is reversed as well, with the chemo occurring before the surgery. However, this combination of surgery and intra-peritoneal chemotherapy is a fairly new procedure and still considered experimental.

In this process the surgeons still remove the tumors using electrosurgical tipped scalpel—which burns or cauterizes the wound, minimizing both tissue damage and the chances of tumor re-growth. However, the patient is then immediately subjected to highly concentrated and targeted chemotherapy. If the tumors are successfully decreased in size to 2.5mm or smaller, then the next phase of the process can begin.

In this case, the chemo medication is administered directly to the diseased peritoneum, the soft tissue which lines the interior of the body’s abdominal cavity. It can either be delivered while the patient’s body cavity is still open from the tumor removal process and the tissue is exposed or it can be delivered via catheters after the body cavity is sewn partially or completely closed.

There are risk and benefits to both the open and closed methods of chemo delivery. In the open process, chemo can be delivered on target with a high degree of certainty because doctors can literally see where they are putting the medication. However, this leaves the surgical staff at risk of exposure to these toxic concoctions and, for the patient, increases the risk of hypothermia from loss of body heat and other post-surgical complications. It may also decrease the effectiveness of the chemotherapy because the chemical concoction must be delivered at a specific and steady temperature to be as effective as possible.

The closed methods decreases the post-surgical complications and nearly eliminates the temperature variations when dealing with chemo delivery, however, doctors cannot see exactly where the medication is being delivered and, therefore, may miss the target.

The chemotherapy drugs most commonly used during this intra-peritoneal process include:
  • Mitomycin C
  • Cisplatin
  • Oxaliplatin
  • Doxorubicin

However, some doctors have had greater success with a dual-mode treatment with 5-fluoruracil and leucovorin pumped in intravenously in conjunction with oxaliplatin-based chemotherapy.

No matter which type of surgery and chemotherapy delivery combination is applied, there are risks involved. Reviewers found mortality rates of patients undergoing this multimodal form of mesothelioma treatment runs between 12% and 52%. The average rate appeared to hover around 17%. As might be expected, the survival rates for patients who underwent his type of surgery at hospitals that commonly perform this procedure were higher. Given the complexities and rarity of this type of asbestos cancer, seeking treatment from a doctor specializing in mesothelioma treatment is always highly recommended.