Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy

Andrew L Feldman, Steven K. Libutti, James F. Pingpank, David L. Bartlett, Tatiana H. Beresnev, Sharon M. Mavroukakis, Seth M. Steinberg, David J. Liewehr, David E. Kleiner, H. Richard Alexander

Research output: Contribution to journalArticle

266 Citations (Scopus)

Abstract

Purpose: Malignant mesothelioma (MM) arising in the peritoneal cavity is a rare neoplasm characterized by peritoneal progression and for which there are limited therapeutic options. We evaluated the peritoneal progression-free and overall survival (PFS and OS, respectively) for patients with peritoneal MM after surgical resection and regional chemotherapy. Patients and Methods: Forty-nine patients (28 males, 21 females; median age, 47 years; range, 16 to 76 years) with MM underwent laparotomy, tumor resection, continuous hyperthermic peritoneal perfusion with cisplatin (median dose 250 mg/m2), and a single postoperative intraperitoneal dwell of fluorouracil and paclitaxel (n = 35) on protocols approved by the Institutional Review Board. Standard techniques for actuarial analyses of potential prognostic variables (Kaplan-Meier method with two-tailed log-rank test and Cox proportional hazards model) were performed. Results: At a median potential follow-up of 28.3 months, median actuarial PFS is 17 months and actuarial OS is 92 months. Factors associated with improved PFS and OS by the Cox proportional hazards model were a history of previous debulking surgery, absence of deep tissue invasion, minimal residual disease after surgical resection (OS only), and age younger than 60 years (OS only). Conclusion: Surgical resection and regional chemotherapy for MM results in durable PFS and OS. Favorable outcome is associated with age, tumor biology (selection of patients with a history of previous debulking), lack of invasive tumor growth, and minimal residual disease after tumor resection.

Original languageEnglish (US)
Pages (from-to)4560-4567
Number of pages8
JournalJournal of Clinical Oncology
Volume21
Issue number24
DOIs
StatePublished - Dec 15 2003
Externally publishedYes

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Statistical Factor Analysis
Drug Therapy
Residual Neoplasm
Proportional Hazards Models
Peritoneal Neoplasms
Neoplasms
Actuarial Analysis
Research Ethics Committees
Peritoneal Cavity
Paclitaxel
Fluorouracil
Laparotomy
Patient Selection
Cisplatin
Disease-Free Survival
Perfusion
Malignant Mesothelioma
Growth
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. / Feldman, Andrew L; Libutti, Steven K.; Pingpank, James F.; Bartlett, David L.; Beresnev, Tatiana H.; Mavroukakis, Sharon M.; Steinberg, Seth M.; Liewehr, David J.; Kleiner, David E.; Alexander, H. Richard.

In: Journal of Clinical Oncology, Vol. 21, No. 24, 15.12.2003, p. 4560-4567.

Research output: Contribution to journalArticle

Feldman, AL, Libutti, SK, Pingpank, JF, Bartlett, DL, Beresnev, TH, Mavroukakis, SM, Steinberg, SM, Liewehr, DJ, Kleiner, DE & Alexander, HR 2003, 'Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy', Journal of Clinical Oncology, vol. 21, no. 24, pp. 4560-4567. https://doi.org/10.1200/JCO.2003.04.150
Feldman, Andrew L ; Libutti, Steven K. ; Pingpank, James F. ; Bartlett, David L. ; Beresnev, Tatiana H. ; Mavroukakis, Sharon M. ; Steinberg, Seth M. ; Liewehr, David J. ; Kleiner, David E. ; Alexander, H. Richard. / Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. In: Journal of Clinical Oncology. 2003 ; Vol. 21, No. 24. pp. 4560-4567.
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AU - Libutti, Steven K.

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AU - Bartlett, David L.

AU - Beresnev, Tatiana H.

AU - Mavroukakis, Sharon M.

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AU - Liewehr, David J.

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AU - Alexander, H. Richard

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N2 - Purpose: Malignant mesothelioma (MM) arising in the peritoneal cavity is a rare neoplasm characterized by peritoneal progression and for which there are limited therapeutic options. We evaluated the peritoneal progression-free and overall survival (PFS and OS, respectively) for patients with peritoneal MM after surgical resection and regional chemotherapy. Patients and Methods: Forty-nine patients (28 males, 21 females; median age, 47 years; range, 16 to 76 years) with MM underwent laparotomy, tumor resection, continuous hyperthermic peritoneal perfusion with cisplatin (median dose 250 mg/m2), and a single postoperative intraperitoneal dwell of fluorouracil and paclitaxel (n = 35) on protocols approved by the Institutional Review Board. Standard techniques for actuarial analyses of potential prognostic variables (Kaplan-Meier method with two-tailed log-rank test and Cox proportional hazards model) were performed. Results: At a median potential follow-up of 28.3 months, median actuarial PFS is 17 months and actuarial OS is 92 months. Factors associated with improved PFS and OS by the Cox proportional hazards model were a history of previous debulking surgery, absence of deep tissue invasion, minimal residual disease after surgical resection (OS only), and age younger than 60 years (OS only). Conclusion: Surgical resection and regional chemotherapy for MM results in durable PFS and OS. Favorable outcome is associated with age, tumor biology (selection of patients with a history of previous debulking), lack of invasive tumor growth, and minimal residual disease after tumor resection.

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