Prospective trial for the treatment of malignant peritoneal mesothelioma

Malignant peritoneal mesothelioma (MPM) is a rare and often rapidly fatal d isease with median survival of 5 to 12 months for untreated cases and 16 mo nths reported after multimodality treatment. We report a prospective clinic al treatment study using cytoreductive surgery combined with intraoperative intraperitoneal heated chemotherapy (IPHC) perfusion using mitomycin C for MPM. Twelve patients (11 male with a mean age 51 years) were treated. Seve n patients presented with bulky disease and seven with ascites. All underwe nt exploratory laparotomy with histologically confirmed diagnosis of MPM. S urgical debulking as feasible was performed. Complete gross tumor removal w as possible in only one patient. Cytoreduction was followed by a 2-hour clo sed low-volume IPHC using mitomycin C. One patient died 50 days postoperati vely from complications relating to small bowel perforation. Hematologic to xicity of the procedure was minimal. Ascites was controlled in all patients and permanently in 86 per cent of patients presenting with ascites. To dat e median survival is 34.2 months with median follow-up of 45.2 months. One patient was re-explored for ventral hernia 2 years post-IPHC, had negative peritoneal biopsies, and remains disease-free at 5 years. Given the dismal prognosis associated with MPM the results of treatment with cytoreductive s urgery combined with IPHC perfusion are encouraging. The rarity of MPM make s appropriately powered prospective randomized trials unlikely. Therefore, we now offer this approach off protocol; however, further study of this com bined modality therapy is warranted.