How Is Peritoneal Mesothelioma Treated?

Treating Peritoneal Mesothelioma

Peritoneal mesothelioma — cancer of the lining of the abdominal cavity — accounts for approximately 15–20% of all mesothelioma diagnoses. Though less common than pleural mesothelioma, peritoneal mesothelioma has seen some of the most significant treatment advances in recent years, particularly through the development and refinement of cytoreductive surgery with heated intraperitoneal chemotherapy (HIPEC).

The treatment approach for peritoneal mesothelioma depends on the extent of disease (as measured by the peritoneal cancer index, or PCI), cell type, and the patient’s overall health. At experienced centers, eligible patients can achieve remarkably improved survival with aggressive surgical treatment.

Cytoreductive Surgery with HIPEC

The combination of CRS and HIPEC has become the gold standard treatment for peritoneal mesothelioma at specialized centers. During CRS, the surgeon systematically removes all visible tumor from the abdominal cavity, which may include stripping the peritoneal lining, removing affected portions of organs, and performing partial organ resections. The goal is complete or near-complete cytoreduction (removal of all macroscopic disease).

Immediately after CRS, heated chemotherapy solution (typically cisplatin at 41–43°C) is circulated throughout the abdominal cavity for 60–90 minutes. The heat enhances drug penetration into tissue and increases the cytotoxic effect against remaining microscopic cancer cells. This combined approach achieves results far superior to either treatment alone.

Outcomes of CRS/HIPEC

Published data from major peritoneal surface malignancy centers demonstrates impressive outcomes. A multi-institutional study reported median survival of 53 months. Some single-center series have reported median survival exceeding 7 years for patients achieving complete cytoreduction with epithelioid cell type. Five-year survival rates of 50–60% have been documented at experienced centers.

These outcomes represent a dramatic improvement over historical results with systemic chemotherapy alone, which typically achieved median survival of 12–16 months. The completeness of cytoreduction is the strongest predictor of outcome — patients with no residual visible disease after surgery have the best prognosis.

Non-Surgical Treatment Options

Patients who are not candidates for CRS/HIPEC — due to extensive disease, poor performance status, or unfavorable cell type — may receive systemic chemotherapy with pemetrexed and cisplatin or carboplatin. Immunotherapy with nivolumab and ipilimumab is another option, particularly for non-epithelioid cell types. Palliative care including paracentesis (draining abdominal fluid) is important for symptom management.

Some centers also offer NIPEC (normothermic intraperitoneal chemotherapy), where unheated chemotherapy is infused into the abdominal cavity through a port over multiple treatment cycles. This approach is used for patients with low-volume disease or as maintenance therapy after CRS/HIPEC.

Finding Specialized Treatment

CRS/HIPEC for peritoneal mesothelioma is a highly specialized procedure best performed at centers with extensive experience. Only a limited number of treatment centers have the expertise to perform this complex surgery safely and effectively. Patients diagnosed with peritoneal mesothelioma should seek consultation at an experienced center before making treatment decisions. Financial compensation for asbestos exposure can help cover the costs of travel and specialized treatment.