Impressive remission of locally advanced malignant peritoneal mesothelioma treated with combination of radiotherapy and intraperitoneal paclitaxel

Abstract

Background: The results of treatment of malignant peritoneal mesothelioma are quite unsatisfactory, especially in the later stages of the disease, regardless of the treatment modality employed.

Case: We report a case of locally advanced malignant peritoneal mesothelioma, in which the combination of radiotherapy and intraperitoneal paclitaxel was beneficial for long-term disease stabilization. A 71-year-old woman presented with abdominal pain. Abdominal ultrasound and magnetic resonance imaging confirmed the presence of a mass with both cystic and solid components with moderate ascites. Serum CA-125 concentration was 727 IU/ml. At exploratory laparotomy, a large mass originating from the pouch of Douglas was found. A total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed with partial excision of the mass and involved the peritoneum of the pouch of Douglas. The histologic study showed malignant peritoneal mesothelioma. One year and five months after surgery, significant progression of the residual tumor with increasing ascites was noted. Radiotherapy to the whole pelvis with 45 Gy in 25 fractions was given over five weeks together with intraperitoneal paclitaxel (60 mg/m2) instillation, which was repeated every three weeks. The patient received eight cycles of paclitaxel instillation over seven months. The compliance of the patient was excellent under therapy and her general condition improved significantly one and half year with a marked regression of the tumor masses after this treatment.

Conclusion: The combination of radiotherapy and intraperitoneal paclitaxel seems suitable in palliative settings primarily aimed at improving the quality of life.