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. 2023 May;30(5):2666-2675.
doi: 10.1245/s10434-022-13061-3. Epub 2023 Feb 8.

Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center

Cristian D Valenzuela  1 , Ian B Solsky  1 , Richard A Erali  1 , Steven D Forsythe  1 , Christopher W Mangieri  1 , Bigyan B Mainali  1 , Gregory Russell  2 , Kathleen C Perry  1 , Konstantinos I Votanopoulos  1 , Perry Shen  1 , Edward A Levine  3
Affiliations

Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center

Cristian D Valenzuela et al. Ann Surg Oncol. 2023 May.

Abstract

Background: Malignant peritoneal mesothelioma (MPM) is a rare diagnosis with a dismal prognosis if untreated. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is shown to significantly improve survival. Our institution is uniquely positioned to report long-term outcomes in MPM with CRS-HIPEC, due to our robust peritoneal surface disease program existing over the past three decades.

Methods: Our prospectively maintained, single-institution database of CRS-HIPEC cases was reviewed, identifying 111 consecutive patients with MPM over 28 years (1993-2021). Prognostic, operative, and pathologic factors were reviewed. Overall survival (OS) and conditional survival (CS) analyses were performed.

Results: The average age was 55.1 years; 58.6% of patients were male; 17 of 111 patients (15.3%) had a second CRS-HIPEC. At first CRS-HIPEC, the average PCI score was 18.7, and the perfusate drugs were platinum-based (72.1%) and mitomycin C (27.9%). The resection status at first CRS-HIPEC was R2a (46.4%), followed by R0-1 (29.1%), and R2b-c (24.5%). Median OS was 3.3 years for the entire cohort, with 75th and 25th percentiles at 10.7 months and 10.6 years. Median CS was improved if patients survived to the 1-year postoperative mark (4.9 years, p < 0.01) and trended toward further improvement with each passing year. If 3-year postoperative survival was achieved, the median CS improved to 6.1 years.

Conclusions: This represents one of the largest and lengthiest, single-center, longitudinal, case series of peritoneal mesothelioma treated with CRS-HIPEC. The OS suggests efficacy for CRS-HIPEC for MPM. Long-term survival improves significantly after patients achieve the 1-year, postoperative mark.

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Figures

FIG. 1
FIG. 1
Overall survival of mesothelioma versus other cancers after CRS-HIPEC
FIG. 2
FIG. 2
Overall survival of mesothelioma after single versus repeat CRS-HIPEC
FIG. 3
FIG. 3
Overall survival of mesothelioma after CRS-HIPEC by perfusate type
FIG. 4
FIG. 4
Overall survival after CRS-HIPEC for mesothelioma, by resection status
FIG. 5
FIG. 5
Conditional survival after CRS-HIPEC for mesothelioma, by postoperative year
See this image and copyright information in PMC

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