747P - Prevalence, clinical features and prognosis of diffuse malignant peritoneal mesothelioma (DMPM): do patients in clinical trials reflect the real wor...

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Mesothelioma
Presenter Federica Grosso
Authors F. Grosso1, D. Degiovanni2, A. Roveta3, S. Barbero4, R. Libener3, F. Musante5, O. Testori6, D. Mirabelli7, P.G. Betta8, M. Botta9
  • 1Oncologia Medica, SS Antonio e Biagio General Hospital, 15121 - Alessandria/IT
  • 2Palliative Care, S Spirito General Hospital, 15033 - Casale Monferrato/IT
  • 3Oncology, SS Antonio e Biagio General Hospital, 15121 - Alessandria/IT
  • 4Radiology, S Spirito General Hospital, 15033 - Casale Monferrato/IT
  • 5Radiology, SS Antonio e Biagio General Hospital, 15121 - Alessandria/IT
  • 6Nuclear Medicine, SS Antonio e Biagio General Hospital, 15121 - Alessandria/IT
  • 7Epidemiology Cancer Unit, University of Tumor, 10036 - Turin/IT
  • 8Lilt, SS Antonio e Biagio General Hospital, 15121 - Alessandria/IT
  • 9Oncology, S Spirito General Hospital, 15033 - Casale Monferrato/IT

Abstract

Background

Peritoneum is the second most frequent site of origin of malignant mesothelioma (MM). DMPM is the most frequent primary peritoneal malignancy in developed countries. Highly specialized centres have reported improved outcomes following an aggressive loco-regional approach, including cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC), with median overall survival (OS) approaching 50 months and almost 50% relapse-free patients at 5 years. Conversely, in population based studies prognosis still remains very poor with OS in the range of 5.7-10. To describe clinical features and prognosis in unselected consecutive patients, we report on the clinical outcome of a series of DMPM treated at a single Oncological Department, in a highly asbestos-polluted area in Piedmont.

Patients and methods

By using our database (MesoDB), we retrieved DMPM patients diagnosed between November 1993 and September 2011 at Alessandria and CasaleMonferratoHospitals. All cases were confirmed by the same expert pathologists.

Results

Among 862 MM we identified 35 patients, 9 F and 26 M. Median age at diagnosis was 67 years, IQR 61-73, range 30-83. Occupational asbestos exposure was definite in 23 and probable in 2 patients, whereas environmental in 10. The histological diagnosis followed a laparoscopic/laparotomic procedure in 25 patients, the other 10 had only US-guided, fine-needle aspiration biopsy. Only 1 patient in the series underwent CRS and PIC. The others were deemed unsuitable for surgery. Ten patients had systemic chemotherapy, 6 pemetrexed and 2 raltritrexed-based. The other 25 received only best supportive care and among these 3 received also subcutaneous IFNbeta or IL2 and 1 intraperitoneal IFNbeta. PFS of the 12 patients receiving systemic therapy was 3.9 months (range 1-7,7). Median OS was 6.1 months (95%CI 2-8,7).

Conclusions

DMPM accounts for 5% of MMs in our mesoDB, a percentage lower than reported in the literature. Outcomes in our patients were more disappointing compared to those reported by referral centres, but similar to population-based studies. These differences emphasize the strict selection of patients enrolled into aggressive loco-regional treatment programs and the need for new therapeutic approaches suitable for the real clinical practice setting.

Disclosure

All authors have declared no conflicts of interest.