Clapper, Patti, Schweizer and Mason

A recent study from medical researchers from the Department of Surgery of Columbia University in New York concluded that two-stage cytoreduction surgery and intraperitoneal chemotherapy is a safe and feasible alternative treatment for diffuse malignant peritoneal mesothelioma. 

Of the three types of mesothelioma (pleural, peritoneal, and pericardia), peritoneal is the second most common, accounting for 10 to 20% of all mesotheliomas.  Peritoneal mesothelioma begins in the protective lining that surrounds the abdomen.  Exposure to asbestos is the primary cause of all types of mesothelioma.

Traditionally, peritoneal mesothelioma is treated with an aggressive operative cytoreduction followed by intraperitoneal chemotherapy.  Operative cytoreduction is surgery that is meant to remove as much of the cancer from the peritoneal surfaces as possible.  This procedure is also commonly referred to as “debulking” – reducing the bulk of cancer cells and visible tumors.  Surgery is then followed by intraperitoneal chemotherapy (also known as Hyperthermic Intraperitoneal Chemotherapy, HIPEC) to destroy the tumors and cancer cells that aren’t visible as to prevent new tumor growth. 

Unfortunately, a high morbidity and mortality rate and post-operative complications are associated with cytoreduction surgery.  The recent study by Columbia investigated the possibility of an alternative treatment protocol to reduce this risk.

Medical researchers conducted a clinical trial where patients underwent two less extensive debulking surgeries (versus the one more aggressive surgery) followed by prolonged heated intraperitoneal chemotherapy.  Overall median survival was between approximately 55 to 70 months, with epitheliod subtypes of peritoneal mesothelioma having the longest survival rates.

The aim of this clinical trial was to discover an alternative treatment protocol that would not have as high a risk of mortality and still prolong post-treatment survival.  Results clearly indicated that the less aggressive double surgery combined with heated chemotherapy was comparable if not preferable to standard one-stage approaches for treating peritoneal mesothelioma tumors.