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The Role of Perioperative Systemic Chemotherapy in Diffuse Malignant Peritoneal Mesothelioma Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

  • Regional Cancer Therapies
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to evaluate the effects of perioperative systemic chemotherapy (CT) on short-term surgical and long-term oncologic results in diffuse malignant peritoneal mesothelioma (DMPM) patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Patients and Methods

We retrospectively analyzed data obtained from an institutional prospective database at NCI of Milan. The study group comprised 116 DMPM patients treated with CRS + HIPEC from August 1995 to October 2011. A total of 60 cases underwent preoperative CT (PRECT), 30 underwent postoperative CT (POSTCT), and 26 did not undergo any CT (NOCT). Also, 55 cases used the perioperative combination of platinum and pemetrexed. We tested whether covariates related to clinical, histologic, PRECT, and surgical treatment were correlated with completeness of cytoreduction (CC), postoperative G3-5 morbidity, and progression-free survival and overall survival (OS). Univariate and multivariate analyses were performed.

Results

Factors independently associated with CC were ECOG performance status (PF) of 0, and PCI <20. Factors independently associated with postoperative G3-5 morbidity were ECOG >1, bowel anastomosis, and number of peritonectomy procedures. Preoperative platelet count >400 × 103/mm3, histological subtype (biphasic and sarcomatoid vs epithelial), CC, and G3-5 morbidity were independent prognostic factors. PRECT was not associated with CC or G3-5 morbidity. There was no significant difference in terms of survival between the PRECT, POSTCT, and NOCT groups.

Conclusions

The CC, G3-5, and OS were not influenced by aspects related to perioperative CT. The present data warrants confirmation reconducting the comparative analysis in a larger multi-institutional series preferably using matching control techniques.

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Acknowledgment

This study was partially supported by Istituto Superiore di Sanità and Italian Health Care System (Bando Ricerca Finalizzata). The authors gratefully acknowledge the support of Dr. Edward Haeusler for the English revision the manuscript.

Conflict of interest

The authors declare that there is no conflict of interest.

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Authors and Affiliations

  1. Peritoneal Surface Malignancy Program, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

    Marcello Deraco MD, Dario Baratti MD & Shigeki Kusamura MD, PhD

  2. University of Medicine and Pharmacy “Gr T Popa”, Iasi, Romania

    Ionut Hutanu MD

  3. Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

    Rossella Bertuli MD

Authors
  1. Marcello Deraco MD
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  2. Dario Baratti MD
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  3. Ionut Hutanu MD
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  4. Rossella Bertuli MD
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  5. Shigeki Kusamura MD, PhD
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Corresponding author

Correspondence to Marcello Deraco MD.

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Deraco, M., Baratti, D., Hutanu, I. et al. The Role of Perioperative Systemic Chemotherapy in Diffuse Malignant Peritoneal Mesothelioma Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 20, 1093–1100 (2013). https://doi.org/10.1245/s10434-012-2845-x

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  • DOI: https://doi.org/10.1245/s10434-012-2845-x

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