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 Quality of Life Still Good with HIPEC Surgery for Peritoneal Mesothelioma

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2019/09/04
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  Quality of Life Still Good with HIPEC Surgery for Peritoneal Mesothelioma
 
  • by Tim Povtak
 
  • Research&Clinical Trials
 
  • May 22 , 2019
 
  Surgical oncologist Dr . Edward Levine was not surprised by the encouraging results of the recent study measuring quality-of-life issues following aggressive treatment for patients with peritoneal mesothelioma . 
 
  He has been seeing it regularly for several years . 
 
  “ It just confirmed my clinical gestalt of how patients
 
  did , ” Levine told The Mesothelioma Center at Asbestos . com . “ But it was nice to now quantify it with standardized , accepted quality-of-life measures . ” 
 
  The potential benefits outweighed the risks . 
 
  Levine , chief of the surgical oncology program at Wake Forest Baptist Comprehensive Cancer Center , is a nationally recognized specialist in peritoneal surface malignancies . 
 
  He is the senior author of the study that questioned 46 mesothelioma patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy , also known as HIPEC . 
 
  Annals of Surgical Oncology published the study in May 2019 . 
 
  Patients completed surveys preoperatively to establish a baseline , then again at three , six , 12 and 24 months after completion of the surgery and HIPEC combination . 
 
  “ Patients who go through the treatment tend to have good quality of life after recovering from the acute effects of surgery , ” Levine said . “ If we can get patients to these procedures , many of them will be long-term survivors . ” 
 
  Procedure Produces Long-Term Survivors
 
  Much of the work was presented at the Society of Surgical Oncology meeting in Chicago last spring . 
 
  Median survival was 3 . 4 years . One- , three-and five-year survival rates were 77.4 % , 55.2 % and 36.5 % , respectively . 
 
  An earlier study at Wake Forest reported a five-year survival rate of 45 % , but it included only patients who achieved a complete cytoreduction . 
 
  Several patients in this latest study had incomplete cytoreduction with only palliative intent . 
 
  The quality-of-life measurements—mental and physical—were considerably higher for those with the complete resection . 
 
  Researchers used multiple verified quality-of-life surveys . The median age of the patients was 52.8 years at time of treatment , and 52%were male . 
 
  Mental and Physical Quality of Life
 
  Patients were questioned on topics such as : 
 
  • Physical functioning
 
  • Bodily pain
 
  • General Health
 
  • Vitality
 
  • Social functioning
 
  • Mental health
 
  • Depression
 
  Researchers concluded that after treatment , quality of life typically went down before it went up . 
 
  When compared to pretreatment measurements , physical function decreased at three months , reached baseline by six months and steadily improved until 24 months . 
 
  The emotional well-being scores also were decreased at three months , but significantly increased through the next 21 months . 
 
  Authors wrote that the initial decrease in quality of life after surgery likely was because of pain and limitations associated with the large incision and physiologic impact of complications . 
 
  They also noted 30% of patients had no significant complications after surgery . 
 
  A decrease in quality-of-life measures after 24 months was attributed to disease recurrence . 
 
  Procedure Has Become Standard of Care
 
  The combination of cytoreduction and HIPEC can be a debilitating procedure , lasting from 8-12 hours . 
 
  The surgeon first removes all visible tumor growth , which often has metastasized throughout the abdominal cavity . 
 
  A heated chemotherapy solution is then circulated for up to 90 minutes before it is removed . 
 
  The high-dose chemotherapy solution is designed to reach the microscopic tumor cells that evaded the surgeon . 
 
  The Peritoneal Surface Oncology Group International began listing the treatment combination as standard of care for peritoneal mesothelioma more than a decade ago . 
 
  “ This is probably the procedure of choice for patients who are candidates for it , ” Levine said . “ But it is a major operative undertaking with significant risks . ” 
 
  Procedure Not for Every Patient
 
  With many patients , the disease is too advanced when first diagnosed that it prevents them from being candidates for this aggressive treatment combination . 
 
  For those who qualify , though , aggressive treatment most often proves to be worth the risk . 
 
  “ This study shows that the improvement in quality of life can be very significant compared with the preoperative status , ” Levine said . “ By six months , virtually all of the patients had recovered to preoperative baseline or better quality-of-life measures . ” 
 
  新闻来源网址 : https : // www . asbestos . com / news / 2019 / 05 / 22 / peritoneal-hipec-quality-life /