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Treatment of Primary Peritoneal Mesothelioma by Continuous Hyperthermic Peritoneal Perfusion (CHPP)

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Abstract

Background: Primary peritoneal mesothelioma is a locally aggressive disease that is difficult to treat or even palliate. Continuous hyperthermic peritoneal perfusion (CHPP) with cisplatin (CDDP) allows uniform, high regional delivery of chemotherapeutics and hyperthermia to the peritoneal surface for the treatment of peritoneal tumors. This article summarizes the results of 18 patients with peritoneal mesothelioma treated with CHPP.

Methods: From June 1993 through April 1998, 18 patients with primary peritoneal mesothelioma (13 male, 5 female; median age, 51 years) underwent surgical exploration and tumor debulking followed by a 90-minute CHPP with CDDP and hyperthermia as part of three consecutive phase I trials conducted at the National Cancer Institute. Seventeen of 18 patients had malignant peritoneal mesothelioma, 13 with associated ascites. One patient had a symptomatic, multiply recurrent, benign, cystic peritoneal mesothelioma. Three patients who had a recurrence after a prolonged progression-free interval (>6 months) after CHPP underwent re-treatment. CHPP parameters included median cisplatin dose of 530 mg (range, 187–816), perfusate volume 6.0 liter (range, 4–9), flow 1.5 liter/min (range, 1–2), intraperitoneal temperature 41°C (range, 38.7–43.2), and central temperature 38.6°C (range, 36.8–39.7).

Results: Median follow-up after CHPP is 19 months (range, 2–56) with no operative or treatment-related mortality. Overall operative morbidity was 24% and included two patients with superficial wound infection and one patient each with atrial fibrillation, pancreatitis, fascial dehiscence, ileus, line sepsis, and clostridium difficile colitis. The major treatment-related toxicity was systemic renal toxicity at doses above what was defined as the maximum tolerated dose of cisplatin. Nine of 10 patients had resolution of their ascites postoperatively. Three patients who developed recurrent ascites (27, 22, and 10 months after initial treatment) were re-treated and had resolution of their ascites with ongoing responses at 24, 6, and 4 months after the second perfusion. The median progression-free survival was 26 months, and the overall 2-year survival was 80%. The median overall survival has not been reached.

Conclusions: CHPP with cisplatin can be performed safely with no mortality and minimal morbidity. In selected patients, successful palliation in the abdomen and long-term survival, compared with historical controls, can be achieved with aggressive surgical debulking and CHPP. Re-treatment after initial response can result in a second long-term response.

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REFERENCES

  1. Connelly RR, Spirtas R, Myers MH, et al. Demographic patterns for mesothelioma in the United States. J Natl Cancer Inst 1987; 78:1053.

    PubMed  CAS  Google Scholar 

  2. Averbach AM, Sugarbaker PH. Peritoneal mesothelioma: treatment approach based on natural history. Cancer Treat Res 1996; 81:193–211.

    PubMed  CAS  Google Scholar 

  3. van Gelder T, Hoogsteden HC, Versnel MA, et al. Malignant peritoneal mesothelioma: a series of 19 cases. Digestion 1989;43: 222–227.

    Article  PubMed  CAS  Google Scholar 

  4. Moertel C. Peritoneal mesothelioma. Gastroenterology 1972;63: 346–350.

    PubMed  CAS  Google Scholar 

  5. Antman KH, Blum RH, Greenberger JS, et al. Multimodality therapy for malignant mesothelioma based on a study of natural history. Am J Med 1980;68:356–62.

    PubMed  CAS  Google Scholar 

  6. Antman K, Shemin R, Ryan L, et al. Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana Farber Cancer Institute and Brigham and Women’s Hospital experience over two decades, 1965–1985. J Clin Oncol 1988;6:147–53.

    PubMed  CAS  Google Scholar 

  7. Antman KH, Pass HI, Recht A. Benign and malignant mesothelioma. In: DeVita V, Hellman S, Rosenberg S, eds. Cancer: Principles and practice of oncology. Philadelphia: Lippincott, 1989: 1399–1417.

    Google Scholar 

  8. Plaus WJ. Peritoneal mesothelioma. Arch Surg 1988;123:763–766.

    PubMed  CAS  Google Scholar 

  9. Falkson G, Hunt M, Borden EC, et al. An extended phase II trial of ifosfamide plus mesma in malignant mesothelioma. Invest New Drugs 1992;10:337–343.

    PubMed  CAS  Google Scholar 

  10. Dedrick RL. Theoretical and experimental bases of intraperitoneal chemotherapy. Semin Oncol 1985;XII:1–6.

    Google Scholar 

  11. Markman M. Intraperitoneal paclitaxel in the management of ovarian cancer. Semin Oncol 1995;22:86–87.

    PubMed  CAS  Google Scholar 

  12. Antman K, Osteen R, Klegar K, et al. Early peritoneal mesothelioma: a treatable malignancy. Lancet 1985;2:977–981.

    PubMed  CAS  Google Scholar 

  13. Lederman GS, Recht A, Herman T, et al. Long-term survival in peritoneal mesothelioma: the role of radiotherapy and combined modality treatment. Cancer 1987;59:1882–6.

    PubMed  CAS  Google Scholar 

  14. Alexander HR, Fraker DL. Continuous hyperthermic peritoneal perfusion with cisplatin in the treatment of peritoneal carcinomatosis. Reg Cancer Treat 1995;8:2–7.

    Google Scholar 

  15. Fujimoto S, Shgrestha RD, Kokubun M, et al. Intraperitoneal hyperthermic perfusion combined with surgery effective for gastric cancer patients with peritoneal seeding. Ann Surg 1988;208:36–41.

    PubMed  CAS  Google Scholar 

  16. Fujimura T, Yonemura Y, Fushida S, et al. Continuous hyperthermic peritoneal perfusion for the treatment of peritoneal dissemination in gastric cancers and subsequent second-look operation. Cancer 1990;65:65–71.

    PubMed  CAS  Google Scholar 

  17. Koga S, Hamazoe R, Maeta M, et al. Prophylactic therapy for peritoneal recurrence of gastric cancer by continuous hyperthermic peritoneal perfusion with mitomycin C. Cancer 1988;61:232–237.

    CAS  PubMed  Google Scholar 

  18. Bartlett DL, Buell JF, Libutti SK, et al. A phase I trial of continuous hyperthermic peritoneal perfusion with tumor necrosis factor and cisplatin in the treatment of peritoneal carcinomatosis. Cancer 1998;83:1251–1261.

    PubMed  CAS  Google Scholar 

  19. Ma GY, Bartlett DL, Reed E, et al. Continuous hyperthermic peritoneal perfusion with cisplatin for the treatment of peritoneal mesothelioma. Cancer J Sci Am 1997;3:174–179.

    PubMed  CAS  Google Scholar 

  20. Alexander HR, Buell JF, Fraker DL. Rationale and clinical status of continuous hyperthermic peritoneal perfusion (CHPP) for the treatment of peritoneal carcinomatosis. In: DeVita V, Hellman S, Rosenberg S, eds. Principles and practices of oncology updates. Philadelphia: J.B. Lippincott, 1995:1–9.

    Google Scholar 

  21. Howell SB, Pfeifle CE, Wung WE, et al. Intraperitoneal cisdiamminedichloroplatinum with systemic thiosulfate protection. Cancer Res 1983;43:1426–1431.

    PubMed  CAS  Google Scholar 

  22. Howell SB, Pfeifle CG, Wung WE, et al. Intraperitoneal cisplatin with systemic thiosulfate protection. Ann Intern Med 1982;97:845–851.

    CAS  PubMed  Google Scholar 

  23. Vogelzang NJ. Malignant mesothelioma: diagnostic and management strategies for 1992. Semin Oncol 1992;19:64–71.

    PubMed  CAS  Google Scholar 

  24. Asensio JA, Goldblatt P, Thomford NR. Primary malignant peritoneal mesothelioma. Arch Surg 1990;125:1477–1481.

    PubMed  CAS  Google Scholar 

  25. Markman M, Cleary S, Pfeifle C, et al. Cisplatin administered by the intracavitary route as treatment for malignant mesothelioma. Cancer 1986;58:18–21.

    PubMed  CAS  Google Scholar 

  26. Markman M, Kelsen D. Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma. J Cancer Res Clin Oncol 1992;118:547–550.

    PubMed  CAS  Google Scholar 

  27. Gilly FN, Carry PY, Sayag AC, et al. Regional chemotherapy (with Mitomycin C) and intra-operative hyperthermia for digestive cancers with peritoneal carcinomatosis. Hepatogastroenterology 1994;41:124–129.

    PubMed  CAS  Google Scholar 

  28. Fujimura T, Yonemura Y, Muraoka K, et al. Continuous hyperthermic peritoneal perfusion for the prevention of peritoneal recurrence of gastric cancer: randomized controlled study. World J Surg 1994;18:150–155.

    PubMed  CAS  Google Scholar 

  29. Yonemura Y, Fujimura T, Nishimura G, et al. Effects of intraoperative chemohyperthermia in patients with gastric cancer with peritoneal dissemination. Surgery 1996;119:437–444.

    PubMed  CAS  Google Scholar 

  30. Canal P, de Forni M, Chatelut E, et al. Clinical and pharmacokinetic study of intraperitoneal cisplatin at two dose levels: 100 mg/m2 alone or 200 mg/m2 with i.v. sodium thiosulfate. JAMA 1989;16:84–86.

    CAS  Google Scholar 

  31. Barlogie B, Corry PM, Drewinko B. In vitro thermochemotherapy of human colon cancer cells with cis-Dichlorodiammineplatinum(II) and Mitomycin C. Cancer Res 1980;40:1165–1168.

    PubMed  CAS  Google Scholar 

  32. Ajani JA, Ilson DH, Kelsen DP. The activity of paclitaxel in gastrointestinal tumors. Semin Oncol 1995;22:46–50.

    PubMed  CAS  Google Scholar 

  33. Howell SB, Zimm S, Markman M, et al. Long-term survival of advanced refractory ovarian carcinoma patients with small-volume disease treated with intraperitoneal chemotherapy. J Clin Oncol 1987;5:1607–1612.

    PubMed  CAS  Google Scholar 

  34. Schwartz E, Maayan C, Mouallem M, et al. Malignant peritoneal mesothelioma: long-term spontaneous clinical remission. Med Pediatr Oncol 1991;19:325–328.

    PubMed  CAS  Google Scholar 

  35. Norman PE, Whitaker D. Nine-year survival in a case of untreated peritoneal mesothelioma. Med J Aust 1989;150:43–44.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

    Bernard J. Park MD, H. Richard Alexander MD, Steven K. Libutti MD, Peter Wu MD, Dan Royalty BA, Karen C. Kranda RN & David L. Bartlett MD

  2. National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B16, Bethesda, MD, 20892

    David L. Bartlett MD

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  1. Bernard J. Park MD
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  2. H. Richard Alexander MD
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  3. Steven K. Libutti MD
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  4. Peter Wu MD
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  6. Karen C. Kranda RN
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  7. David L. Bartlett MD
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Correspondence to David L. Bartlett MD.

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Park, B.J., Alexander, H.R., Libutti, S.K. et al. Treatment of Primary Peritoneal Mesothelioma by Continuous Hyperthermic Peritoneal Perfusion (CHPP). Ann Surg Oncol 6, 582–590 (1999). https://doi.org/10.1007/s10434-999-0582-6

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  • DOI: https://doi.org/10.1007/s10434-999-0582-6

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