New research suggests that patients with peritoneal mesothelioma may have a better chance of survival if chemotherapy is used in conjunction with cytoreductive surgery.

Mesothelioma affects over 2,500 Americans a year and claims approximately 3,000 lives. The rare form of the ultra-aggressive cancer known as malignant peritoneal mesothelioma typically has a poor prognosis.

Peritoneal mesothelioma is caused by exposure to asbestos, a microscopic natural fiber that was used heavily in industry. Asbestos is said to reach the abdominal wall by one of two methods. The first is through ingested asbestos fibers which are processed through digestion and become lodged in the peritoneum. The other method is through the lungs and lymph nodes by inhaled asbestos fibers.

Many of those who have worked with asbestos materials have developed peritoneal mesothelioma as a result of exposure to asbestos fibers. Asbestos was used in a myriad of industrial materials and construction products. Exposure to asbestos was common in aluminum plants, steel mills, power plants, and naval shipyards.

Peritoneal mesothelioma is a relatively rare disease, with only 200-500 diagnoses each year in the United States being documented. Risk, however, is sustained in those who have been exposed to asbestos. Even those exposed many years ago are potentially at risk for the development of malignant peritoneal mesothelioma. Latency between exposure to asbestos and the development of peritoneal mesothelioma symptoms can range anywhere from 20-50 years. Misdiagnosis is common because peritoneal mesothelioma symptoms closely mimic minor stomach or abdominal discomfort and hernia.

New Treatments Are Promising

Prognosis of mesothelioma patients is poor, and peritoneal mesothelioma patients are no exception. Most peritoneal treatment regimens for patients include palliative methods such as mesothelioma chemotherapy and radiation therapy.

The most promising therapy for peritoneal mesothelioma may be hyperthermic intraperitoneal chemotherapy (HIPEC), a multimodal therapy that combines surgery and heated chemotherapy.  However, researchers from a new study published in the World Journal of Gastroenterology were able to use a method called cytoreductive surgery (CRS) combined with heated intraperitoneal chemotherapy (HIPEC) to achieve a 43.6% cure rate for long-term survivors in the pool of 108 patients. Boasting a median overall survival of 63.2 months for patients in the study, the CRS/HIPEC treatment can be classified as encouraging for those suffering from peritoneal mesothelioma.

The cytoreductive surgery portion of the treatment begins with surgeons removing all traces of the malignant tumor to prevent it from growing back in the future. Afterwards, a heated solution of chemotherapy medicine is targeted into the abdominal cavity to kill any stray cells that could impact other organs. Following the procedure, most patients experienced no mesothelioma growth for more than two years.

Although major complications from the CRS/HIPEC procedure occurred in about 38% of patients, the survival rates are promising. In fact, 19 out of 39 patients survived more than 7 years with peritoneal mesothelioma. Scientists are also seeking to single out molecular targets as an alternative treatment for  peritoneal mesothelioma.  One of the newest targets is sphingosine kinase 1 (SphK1) which regulates the production of a lipid that has been linked to mesothelioma.