For patients with confirmed MPM, radical resection is associated with better prognoses and should be pursued when possible. Other treatments for peritoneal mesothelioma include intensive loco-regional therapeutic strategies: cytoreductive surgery, hyperthermic intraoperative or early postoperative intraperitoneal chemotherapy, and immunotherapy.
Surgery can achieve a complete or incomplete resection. The aim of cytoreductive surgery is to remove as much tumor as possible, as it is often not possible to achieve a complete resection. After surgical debulking, the resection can be classified according to the Completeness of Cytoreduction Score,[45] which evaluates the residual peritoneal mesothelioma seeding within the operative field: complete (CC-0) or partial with a diameter of the residual nodules < 0.25 cm (CC-1), 0.25-2.5 cm (CC-2), > 2.5 cm or confluence of tumor nodules (CC-3). The CC-1 tumor nodule size is thought to be penetrable by intracavitary chemotherapy and is, therefore, designated as complete cytoreduction if perioperative intraperitoneal mesothelioma chemotherapy is used. The limitation of this score is the fact that it can be evaluated only after surgery; therefore, no preoperative informations can be obtained about the resectability of the tumor.
Survival after cytoreductive surgery and intraperitoneal chemotherapy is 35.8 months for patients treated with a CC-0 or CC-1 resection, and only 6.5 months for those treated with a CC-2 or CC-3 resection.[46] Widely used in both noninvasive and invasive peritoneal surface malignancy, the completeness of cytoreduction score is thought to be the principle prognostic indicator.
Chemotherapy mesothelioma has an important role in palliation. It can be administered systemically or directly into the abdomen. The overall response rate reported with a single agent chemotherapy, combined chemotherapy, intraperitoneal chemotherapy, continuous hyperthermic peritoneal perfusion are 13.1%, 20.5%, 47.4%, and 84.6%, respectively.
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