Search

Malignant peritoneal mesothelioma (MPM) is an incurable disease. It represents approximately 15% of all mesotheliomas and has a male predominance. It has a known relationship to asbestos, but most patients present with no known history of exposure. Simian virus 40 (SV40) exposure is potentially another risk factor, although the relationship is not entirely supported. Patients usually present with vague symptoms. Diagnosis is usually made on the basis of a CT scan and percutaneous or open biopsy. The disease remains confined to the abdominal cavity until very late in the disease course. Ascites is a frequent sign; morbidity and mortality are usually a consequence of disease progression within the abdominal cavity. Systemic chemotherapy and radiation have not yet been shown to have much influence over the natural history of the disease. In selected patients, surgical cytoreduction with intraoperative hyperfhermic peritoneal chemotherapy is associated with long-term survival. A summary of clinical experience with surgical cytoreduction and intraoperative intraperitoneal chemotherapy for MPM is presented.

Many individuals afflicted with solid organ malignancies suffer from recurrence of disease limited to a particular region or organ of the body that is not amenable to surgical resection. For these individuals systemic combination chemotherapy may offer palliative benefits and, except for ovarian carcinoma, is rarely curable. Moreover, the maximum doses of systemically administered chemotherapeutic agents are almost invariably limited by the occurrence of severe systemic toxicity. Regional cancer treatments are those that are directly delivered to a cancer-bearing organ or region of the body. The rationale for such therapies is to intensify treatment to the site of a progressively growing cancer while minimizing or potentially eliminating unnecessary systemic toxicity.

Patients who have unresectable primary or metastatic cancers of the liver or peritoneal carcinomatosis are rarely curable. The large number of regional treatments for the liver or peritoneal cavity that are under clinical evaluation underscore the difficulty in treating these conditions. In general, the rationale for regional therapies to intensify therapy, while minimizing unnecessary systemic toxicity, has been well established (1–3). Over the past 6 yr, regional treatment protocols, using specialized surgical techniques to deliver regional therapy to the peritoneal cavity or liver, have been under clinical evaluation in the Surgery Branch of the National Cancer Institute (NCI). These include isolated hepatic perfusion (IHP) for the treatment of unresectable primary or metastatic cancers confined to the liver, and continuous hyperthermic peritoneal perfusion (CHPP) for the treatment of, or prophylaxis against, peritoneal carcinomatosis.