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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2015

01-05-2015 | Regional Cancer Therapies

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: A Systematic Review and Meta-analysis

Authors: Joseph H. Helm, MD, John T. Miura, MD, Jason A. Glenn, MD, Rebecca K. Marcus, MD, Gregory Larrieux, MD, Thejus T. Jayakrishnan, MD, Amy E. Donahue, MLIS, T. Clark Gamblin, MD, MS, Kiran K. Turaga, MD, MPH, Fabian M. Johnston, MD, MHS

Published in: Annals of Surgical Oncology | Issue 5/2015

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Abstract

Background

Due to the increased adoption of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), patients with malignant peritoneal mesothelioma (MPM) have seen improved outcomes. We aimed to evaluate and synthesize the recent published literature.

Methods

The review was conducted according to the recommendation of the Meta-Analysis of Observational Studies in Epidemiology group with prespecified inclusion and exclusion criteria. The DEALE method was used to combine mortality rates, and imputation techniques were used to calculate standard errors. Meta-regression techniques were used to synthesize data. Publication bias was assessed using funnel plots.

Results

Of 6,528 citations collected, 20 articles reporting on 1,047 patients were included in the analysis. The median age was 51 years (interquartile range 49–55), with 59 % (54–67) female. The median peritoneal carcinomatosis index score was 19 (16–23). Complete cytoreduction (CC0, 1) was performed in 67 % (46–93 %) of patients. Pooled estimates of survival yielded a 1-, 3- and 5-year survival of 84, 59, and 42 %, respectively. Patients receiving early postoperative intraperitoneal chemotherapy [EPIC] (44 %) and those receiving cisplatin intraperitoneal chemotherapy alone (48 %) or in combination (44 %) had an improved 5-year survival.

Conclusions

While CRS + HIPEC has led to an improved survival for patients with MPM compared to historic data, heterogeneity of studies precludes generalizable inferences. EPIC chemotherapy and cisplatin chemoperfusion may infer survival benefit.
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Metadata
Title
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: A Systematic Review and Meta-analysis
Authors
Joseph H. Helm, MD
John T. Miura, MD
Jason A. Glenn, MD
Rebecca K. Marcus, MD
Gregory Larrieux, MD
Thejus T. Jayakrishnan, MD
Amy E. Donahue, MLIS
T. Clark Gamblin, MD, MS
Kiran K. Turaga, MD, MPH
Fabian M. Johnston, MD, MHS
Publication date
01-05-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 5/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3978-x

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