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Malignant peritoneal mesothelioma: Treatment

Authors
H Richard Alexander, Jr, MD
Hedy Lee Kindler, MD
Section Editor
Kenneth K Tanabe, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Malignant peritoneal mesothelioma (MPM) is an aggressive neoplasm that arises from the lining mesothelial cells of the peritoneum and spreads extensively within the confines of the abdominal cavity. Morbidity and mortality are almost entirely due to disease progression within the peritoneum and not distant metastatic spread.

This topic review will cover the treatment of MPM. The epidemiology, histology, clinical features, diagnosis, and staging of MPM, as well as the treatment of pleural, pericardial, and tunica vaginalis mesothelioma are presented elsewhere. (See "Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging" and "Epidemiology of malignant pleural mesothelioma" and "Presentation, initial evaluation, and prognosis of malignant pleural mesothelioma" and "Initial management of malignant pleural mesothelioma" and "Systemic treatment for unresectable malignant pleural mesothelioma".)

GENERAL PRINCIPLES AND PROGNOSTIC VARIABLES

There is no consensus as to the optimal treatment for malignant peritoneal mesothelioma (MPM). Due to the rarity of this entity, most of the available clinical information about MPM treatment is derived from retrospective single-center series, which have inherent selection biases. Prospective clinical trials are few and small, and there are currently no randomized studies that compare one treatment with another. Much of the data on systemic chemotherapy in MPM are derived from pharmaceutical company Expanded Access Programs, which have more heterogeneous patient populations and less rigorous response assessment and toxicity reporting than a prospective clinical trial. Determinations about the activity of chemotherapeutic agents are often extrapolated from the more extensive data available from patients with pleural mesothelioma. (See "Systemic treatment for unresectable malignant pleural mesothelioma".)

Compounding the difficulty of interpreting data from select small series, MPM is quite heterogeneous in its clinical behavior (particularly between men and women) [1,2]. There are many prognostic variables, some of which are only evident at surgical evaluation. The different histologic types have different natural histories; the sarcomatoid subtype has a worse prognosis than the more common epithelial subtype [3,4], and there are two variants, both of which arise predominantly in women, that are associated with indolent clinical behavior. (See "Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging", section on 'Histology' and 'Peritoneal mesothelioma variants' below.)

The following sections will focus on diffuse MPM, the most common type of clinical presentation. Management of the well-differentiated papillary and multicystic variants is described below. (See 'Peritoneal mesothelioma variants' below.)

                 

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Literature review current through: Nov 2016. | This topic last updated: Wed May 06 00:00:00 GMT+00:00 2015.
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