Survival Improves for Peritoneal Mesothelioma Patients in Finland
April 1, 2019
Survival time improved significantly for peritoneal mesothelioma patients in Finland who underwent a combination of surgery and chemotherapy, according to a recently released study.
The five-year survival rate was 66 percent. The median survival was 62 months.
According to a smaller, previous study in Finland, the median survival without mesothelioma treatment was just four months after diagnosis.
“Despite these advances in treatment…the majority of patients with malignant peritoneal mesothelioma receive only palliative care of systemic chemotherapy, leaving many eligible patients without the benefit of this more invasive treatment modality,” study authors wrote.
Anticancer Research published Finland’s first multicenter nationwide study of peritoneal mesothelioma in its February 2019 issue.
The research team was from the University of Helsinki, the Helsinki University Hospital and the department of surgery at Kuopio University Hospital in Kuopio, Finland.
“We assessed the effectiveness of the different treatment modalities given to these patients,” the authors wrote. “The aim was to clarify the effectiveness of different modalities on different histological subtypes and in patients exposed to asbestos.”
Many Received No Treatment
Peritoneal mesothelioma is a rare cancer caused primarily by the ingestion of asbestos fibers.
It is the second-most-common form of the disease and begins in the tissue lining of the abdomen.
It also is considered more treatable than the more prevalent pleural mesothelioma, which starts in the thoracic cavity.
Of the 94 patients in this retrospective study, 50 received either chemotherapy, radiation or surgery, or some combination of the three.
The other 44 received either no treatment or only treatment with a palliative intent.
Only 15 of the 50 patients underwent surgery, and only six of those surgeries were with curative intent.
Two of those six surgeries were accompanied by hyperthermic intraperitoneal chemotherapy — also known as HIPEC — along with adjuvant chemotherapy.
Four of the surgeries included only adjuvant chemotherapy.
“Radical surgery with chemotherapy and CRS [cytoreductive surgery] with HIPEC were associated with superior overall survival,” the authors wrote. “An interesting observation was that survival results for patients not treated with HIPEC were even better than for those treated with HIPEC.”
Three of the four patients treated with radical surgery and adjuvant chemotherapy survived at least five years after diagnosis.
HIPEC Is Treatment of Choice Today
The cytoreductive surgery and HIPEC combination in the United States has become the most effective tool in treating peritoneal mesothelioma.
A 2017 study from New York-Presbyterian Hospital and Columbia University Medical Center showed a median survival of 6.65 years for patients having the surgery and HIPEC combination.
Almost 30 percent of the patients survived 10 years or more.
The median, recurrence-free survival was 38.5 months, and 80 percent of the patients received some form of iterative treatment, including a second cytoreduction and more HIPEC.
In Finland, though, HIPEC was slower to become a part of treatment. It wasn’t until 2007 that it was used in the country, more than a decade after the United States.
Histology Makes a Big Difference
Of the 50 patients who received some form of treatment, only 25 listed a histological subtype.
Median survival was nine months after the diagnosis of epithelial, two months after the biphasic subtype and only one month after sarcomatoid.
Systemic chemotherapy improved six-month survival to 79 percent among all patients.
When comparing the effectiveness of different chemotherapy agents, the study listed Alimta (pemetrexed) and the combination of the drug and cisplatin as having median survivals of 23 and 12 months, respectively.
“Treatment methods may be diverse due to the rarity of the disease, and difficulties in diagnostics,” the authors concluded. “Patients considered candidates for radical surgery should be sent to specialized centers for assessment.”