Quality of Life Still Good with HIPEC Surgery for Peritoneal Mesothelioma

　　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 . ” 

 

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