Mesotheliomas are aggressive and lethal
neoplasms arising from mesothelial cells lining the pleura, peritoneum, tunica vaginalis testis and pericardium. Malignant peritoneal
mesothelioma accounts for about 30% of all
mesotheliomas.
Asbestos is the main known cause of the disease. Presenting symptoms in these patients include:
ascites,
abdominal pain,
asthenia,
weight loss,
anorexia, abdominal mass,
fever,
diarrhea and
vomiting. Electron microscopy, immunohistochemistry, computed tomography scan, echotomography, magnetic resonance imaging, positron emission tomography and laparoscopy are used in diagnosis and follow-up.
Chemotherapy alone is considered as a
palliative treatment for these patients who are not eligible for radical surgery. The most promising non-surgical approach today in the management of peritoneal
mesothelioma is the use of the
combination chemotherapy regime of an
antifolate (
pemetrexed and
raltitrexed) and a
platinum based (
cisplatin) agent with a median survival of about 12-14 months. Due to peritoneal confinement of
malignant mesothelioma and low occurrence of
metastasis, a locoregional approach consisting of
cytoreductive surgery and perioperative intraperitoneal
chemotherapy has been introduced as a curative treatment option over the last decade with an overall 5-year survival rate of 29-63%. In this locoregional approach, surgery can separate the adhesions and remove the bulky
tumor, leaving microscopic
residual tumors much more susceptible to the killing effect of chemotherapeutic drugs. Here in St. George hospital,
cytoreductive surgery and
hyperthermic intraperitoneal chemotherapy (using
cisplatin and
doxorubicin) resulted in significant survival advantage. This article describes how the prognosis of the disease has changed over the last decade.