Clinical Fellow Wake Forest Baptist Medical Center Winston-Salem, North Carolina, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Participants should be aware of the following financial/non-financial relationships:
Cristian D. Valenzuela, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Introduction: Peritoneal mesothelioma is an ultrarare cancer with a dismal prognosis if untreated. In the 1990s, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) was shown to significantly improve survival in disease limited to the peritoneum. However, due to its rarity, prognostic reports have been limited to relatively small single-institution series, or pooled series over multiple institutions. Our institution is uniquely positioned to report long-term outcomes in peritoneal mesothelioma, having an established Peritoneal Surface Malignancy Center of Excellence for over 28 years.
Methods: A prospectively maintained single-institution database of all HIPEC cases was retrospectively reviewed, focusing on our set of 107 consecutive patients with peritoneal mesothelioma treated with HIPEC over the past 28 years (1993-2021). Clinical and pathologic factors were reviewed, and overall survival (OS) and conditional survival (CS) analyses were performed.
Results: The average age at HIPEC was 53.6 years. 58.9% of patients were male and 41.1% were female. 17 of 107 patients (15.9%) went on to receive a repeat HIPEC. The average peritoneal cancer index (PCI) score was 18.5. The most frequently used perfusate was Cisplatin (70.1%) followed by Mitomycin C (21.5%), the latter of which was used more frequently in early years of our series. The most common resection status was R2a (44.9%), followed by R0/1 (29.9%), and R2b/c (25.2%). Median OS was 3.3 years for the entire patient population, with 75th and 25th percentiles at 9.0 months and 10.6 years, respectively. Median CS was significantly improved if patients survived to the 1-year post-operative mark (4.9 years, p< 0.01), and trended towards further improvement with each passing year (Figure). If 3-year post-operative survival was achieved, the median CS improved to 6.1 years.
Conclusions: This represents one of the largest reported single-center longitudinal case series of peritoneal mesothelioma treated with HIPEC. The median OS in this analysis is consistent with the reported literature. Long-term survival improves significantly after patients achieve the 1-year post-operative mark.
Learning Objectives:
Upon completion, participants will be able to understand the overall poor prognosis of peritoneal mesothelioma, including after treatment with cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC).
Upon completion, participants will be able to describe how the conditional survival of peritoneal mesothelioma treated with HIPEC improves significantly if the patient survives to the one-year post-operative timepoint.
Upon completion, participants will be able to outline the chemotherapy agents used in our institution for mesothelioma HIPECS, as well as the resection statuses achieved during cytoreduction for peritoneal mesotheliomas.
