Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Malign Peritoneal Mesothelioma: Clinical Aspects and Therapeutic Perspectives

Malignant mesotheliomas develop commonly in the pleural cavity and second mesotheliomas arise in the peritoneal cavity (20–30%). Most frequent symptoms/signs are ascites (77%) and abdominal pain (f69%). Biopsy in these patients should be taken from the peritoneum by invasive method (laparotomy, laparoscopy and core needle biopsy). The couplet of systemic pemetrexed and cisplatin had an overall response rate of approximately 25% and a median overall survival of approximately 1 year. Patients with a good general condition, epithelioid histology, nonabdominal disease, complete or near cytoreduction (CC0/CC1), low Ki67 proliferative index and peritoneal cancer index (PCI) score less than 17 should be administered through cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) rather than palliative systemic chemotherapy. The survival rate with Ki67 ≤ 9% is higher than patients with Ki67 > 9. The basic principles of the CRS are not different from other peritoneal carcinomas. The combination of cisplatin and doxorubicin is the best recommended drug regimen for the hyperthermic intraperitoneal chemotherapy.