Clapper, Patti, Schweizer and Mason

Peritoneal mesothelioma is a rare type of abdominal cancer for which a bimodal approach combining cytoreductive surgery with chemotherapy is often the preferred method of treatment.  However, new research by Portilla Gómez et al suggests that certain types of biphasic mesothelioma should be excluded from this treatment procedure. 

Biphasic mesothelioma is the second most common histological type of this form of cancer.  It represents roughly 20% of all mesothelioma cases, though some research indicates that number may be higher than previously thought due to misdiagnosis as epithelioid mesothelioma.  It’s called biphasic because the tumors are comprised of cells from both the epithelioid and sarcomatoid histological types.  Depending on the concentrations of these two cell types, the biphasic mesothelioma may be classified as sarcomatous due to containing more sarcomatoid cells.  These instances of biphasic mesothelioma may respond to treatments in a manner that’s more typical of sarcomatoid mesotheliomas, which is to say not well. 

This new research suggests that cytoreductive surgery combined with perioperative intraperitoneal chemotherapy may not be as effective a mesothelioma treatment approach in patients suffering from sarcomatous biphasic types.  Indeed, these patients may actually fare worse after surgery than they would have if left alone. 

The study examined 50 patients of the peritoneal carcinomatosis program at the San Jose Policlinic in Vitoria, Spain.  These cases were recorded between December 1998 and December 2005 and represented 78 individual cytoreductive surgeries.  Of that sample group, seven patients were singled out.  They had undergone 11 separate cytoreductive surgeries at the policlinic, and at least one before coming to the clinic or entering that specific program during that time period.  Four of the patients were men and three women.  They ranged in age from 31 to 57 with an average of age 50. 

These seven patients went under the knife for cytoreductive surgery and were then provided with intraperitoneal chemotherapy during the surgical procedure.  This was an attempt at curative treatment with the goal of completely removing the tumor and killing any free-floating or invisible cancer cells. 

After the tumor removal, histological staining showed that two of these seven patients were suffering from sarcomatous biphasic mesothelioma while the remaining five were diagnosed with epithelial mesothelioma.  Epithelioid mesothelioma is the most common form of mesothelioma, representing up to 70% of all cases.  It is also the most treatable.

After surgery only three of the patients died within 11 months.  This included both patients diagnosed with sarcomatous biphasic mesothelioma.  The other four patients lived for at least the entire duration of the study (54 months) or longer. 

The high mortality rate of this small selection of mesothelioma patients was not unexpected.  Even with treatment many patients still die within one or two years after surgery.  However, what struck these Spanish researchers was that both patients with biphasic sarcomatous mesothelioma died while only one of the epithelial mesothelioma patients succumbed to the disease. 

This led the research team to recommend that, in the future, patients suffering from this specific type to seek alternative mesothelioma treatments.  They judged the risks and effect on post-surgical prognosis to be too great to recommend this bimodal treatment to these patients.

Instead, they said a more conventional approach to treatment was probably best within this subset of mesothelioma patients.  In addition, they recommended only palliative treatments, rather than curative.  Which means mesothelioma doctors, in their opinion, should not be overly aggressive in their attempts to cure patients with sarcomatous biphasic mesothelioma.  They should merely try to treat the symptoms and maintain as high a quality of life for the patient as possible.

However, an individual mesothelioma patient’s treatment regimen should be decided upon by agreement between the patient and their primary doctor or oncologist.  Every mesothelioma case is different and treatments need to be specifically tailored to fit the individual. 

If you or a loved one has been diagnosed with mesothelioma, please review the most current research on mesothelioma treatment that we post here.  For further help, call 1-800-440-4262.  We have been representing mesothelioma patients and their families for over 30 years and have a wealth of knowledge that can help you get the best treatment possible.