Abdominal pain, abdominal distention, and the presence of a tumor mass in computed tomography scans are all associated with the recurrence of malignant peritoneal mesothelioma following surgical removal of the tumor, according to a recent study published in the European Journal of Surgical Oncology.
The study, “Symptoms, signs and radiologic findings in patients having reoperative surgery for malignant peritoneal mesothelioma,” also shows that an abdominal or pelvic mass is associated with poorer prognosis, whereas the absence of radiologic abnormalities generally predicts an improved prognosis.
Malignant peritoneal mesothelioma (MPM) is a rare disease that is confined to the abdomen and pelvis throughout its development. Despite great improvements in the treatment of MPM with the use of cytoreductive surgery and perioperative chemotherapy regimens, it is estimated that 50 percent of patients will have a recurrence.
The symptoms, signs, and radiologic findings of patients with primary malignant mesothelioma have been determined, but there is a considerable lack of information regarding the clinical features that are associated with recurrent MPM. Identifying the patients that will benefit from additional surgical intervention may lead to improved survival of patients who progress.
In this study, researchers from Quiron Hospital in Spain and the Program in Peritoneal Surface Malignancy at the MedStar Washington Hospital Center examined a database of 130 MPM patients, all of whom underwent adequate cytoreduction and received Alimta (pemetrexed) and Platinol (cisplatin).
Among them, 38 patients had to receive at least a second intervention after a median of 14 months. In total, these patients had 50 reoperations, after which patients were still determined to have disease progression.
The most common signs and symptoms found in patients who had disease recurrence were abdominal pain (40 percent) and abdominal distention (34 percent). The most common radiologic finding was tumor mass, found in 56 percent of patients, followed by ascites, the buildup of fluid in the abdominal cavity, which was observed in 22 percent of patients.
The researchers found that the median survival for the 38 patients was 62.5 months, with a five-year survival of 41.6 percent. However, the 11 patients who had no radiological findings showed a median survival of 83 months, showing that the absence of radiologic abnormalities was significantly associated with improved prognosis.
However, having a pelvic mass was significantly associated with a worse prognosis in recurrent MPM patients.
“Recognition of this recurrence and knowledgeable selection for additional surgical intervention is important in improving survival of patients who progress,” the study’s authors wrote.