Efficacy of Bidirectional Chemotherapy – Although malignant peritoneal mesothelioma doesn’t have a defined staging system, many doctors rely on the Peritoneal Cancer Index (PCI) to determine the stage of the disease. PCI breaks the abdominal area into 13 distinct regions, which are then scored 0 to 3 based on the presence and size of tumors.
The total score indicates a stage of disease, with the highest score of 39 indicating stage 4 mesothelioma.
Patients with a higher PCI score are generally not eligible for surgery. Instead, patients with a more advanced form of the disease may be treated with other standard treatments, like systemic chemotherapy or radiation therapy. Research indicates these therapies are less effective in peritoneal mesothelioma and may be applied palliatively, to reduce symptoms, rather than extend life expectancy.
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However, new research suggests a newer application of chemotherapy can allow patients with previously unresectable disease to undergo surgery.
Bidirectional chemotherapy works by combining intravenous chemotherapy with intraperitoneal chemotherapy, where the therapy is delivered directly into the abdominal cavity through a catheter. The dual application is more targeted than intravenous chemotherapy alone.
A new case study from Université de Lille observed the impact of bidirectional chemotherapy in a 55-year-old patient with stage 4 peritoneal mesothelioma. The patient indicated a PCI score of 39 before treatment. Doctors further noted the patient had a thickened omentum (i.e., the abdominal membrane connecting the stomach to other organs) and ascites (i.e., increased fluid in the abdominal cavity).
Doctors applied intravenous chemotherapy consisting of cisplatin with pemetrexed and intraperitoneal chemotherapy of cisplatin alone. The patient’s response to the bidirectional chemotherapy was recorded through a CT scan and laparoscopy (a camera-assisted biopsy) to view the abdominal wall.
Following bidirectional chemotherapy, doctors noted the PCI score remained 39, but the patient experienced a macroscopic response. Because the tumors and thickened omentum seemed thinner overall, the patient was then eligible for cytoreductive surgery with HIPEC to extend survival.