Sooner is better when it comes to aggressively treating peritoneal mesothelioma cancer with a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Waiting could cost a patient months of survival. Rejecting surgery could cost them years.
The Journal of Gastrointestinal Surgery published a study in November that showed for the first time to what degree a delay in having the mesothelioma surgery, or not getting it at all, can affect overall survival for patients.
Results of the mesothelioma study were presented earlier this year at the annual Society for Surgery of the Alimentary Tract meeting in San Diego.
Surgeons and oncologists from Abramson Cancer Center at the University of Pennsylvania, Sidney Kimmel Medical College in Philadelphia and the University of Colorado Hospital in Aurora co-authored the study.
“These findings reinforce the important role timely surgery can play in patients with peritoneal mesothelioma,” surgical oncologist and co-author Dr. Giorgos Karakousis, of Abramson Cancer Center, told The Mesothelioma Center at Asbestos.com.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, also known as CRS-HIPEC, has become an effective treatment of choice for mesothelioma specialists in recent years.
This latest life expectancy simulator looked at 1,000 cases of peritoneal mesothelioma in three different categories: timely treatment (fewer than four weeks after diagnosis), delayed treatment (4-24 weeks after diagnosis) and no treatment.
Based on analytic findings, the average life expectancies from time of diagnosis were:
|TREATMENT TIMING||LIFE EXPECTANCY|
|Timely (fewer than 4 weeks from diagnosis)||5.24 years|
|Delayed (4-12 weeks)||4.8 years|
|Delayed (13-24 weeks)||4.37 years|
|No Treatment||2.11 years|
Despite the life expectancy differences, authors estimate three out of five patients who are potential candidates for the combination do not receive it. They cited limited access to mesothelioma specialists, or oncologists still not knowledgeable enough about the advantages and eligibility qualifications to recommend it.
“Patients with a new diagnosis of peritoneal mesothelioma should seek early referral for consideration at a center with specialized expertise,” Karakousis said.
Peritoneal mesothelioma is a rare cancer caused by an ingestion or inhalation of toxic asbestos fibers. It starts in the thin layer of tissue lining the abdomen, but it can take decades before obvious symptoms appear.
The majority of oncologists in the U.S. rarely see cases of mesothelioma. The study highlighted the importance of finding a mesothelioma specialty center for optimal care.
Peritoneal mesothelioma is considered more treatable than pleural mesothelioma, which develops around the lungs and has a shorter median survival. There is no definitive cure for either type of mesothelioma.
An accurate diagnosis is difficult, which often adds to the delay in finding an effective mesothelioma treatment. Early symptoms often are the same as other abdominal issues, including fatigue, fever, loss of appetite, nausea and abdominal pain.
The majority of patients diagnosed with mesothelioma are treated only with standard chemotherapy, followed by palliative care.
The CRS-HIPEC procedure is complex and can last as long as 12 hours. The lengthy, detailed mesothelioma surgery attempts to remove all visible cancer cells, which can be spread throughout the abdomen and involve numerous organs.
HIPEC, which immediately follows the cytoreductive surgery, involves circulating heated chemotherapy throughout the abdominal cavity. The intent is to kill any microscopic tumor cells that evaded the surgeon. The chemotherapy circulates for up to 90 minutes before being drained.
Authors of the recent study concluded that there continue to be missed opportunities to maximize survival with peritoneal mesothelioma, and offered this study to educate patients and clinicians.
“To date, there have been no randomized controlled studies evaluating the surgical management of MPM [malignant pleural mesothelioma], and where such trials do not exist, [this] model may offer utility for clinicians,” the study concluded.