Therapeutic Strategies for Well-differentiated Papillary Mesothelioma of the Peritoneum
Young Ki Lee ; Hyun Jung Jun ; Ji Hae Nahm ; Tae Seop Lim ; Ji Soo Park ; Joong Bae Ahn ; Sun Young Rha ; Hyun Cheol Chung ; Hwa Eun Oh ; Ji-Sun Song ; Woo Ick Yang ; Hyo Song Kim
Japanese Journal of Clinical Oncology, Vol.43(10) : 996~1003, 2013
Japanese Journal of Clinical Oncology
Well-differentiated papillary mesothelioma is an uncommon subtype of mesothelioma with a frequently indolent course, although it occasionally manifests in a more aggressive form. To establish a treatment strategy for this rare disease, we report the clinical characteristics and outcomes of 15 patients with well-differentiated papillary mesothelioma.
All pathologically diagnosed well-differentiated papillary mesothelioma cases were reviewed between 1998 and 2012.
Of the 15 cases, 8 and 7 presented with single and multiple lesions, respectively. All cases with single lesions were asymptomatic, while 4 out of the 7 cases with multiple lesions were symptomatic. After tumor excision, none of the eight single-lesion cases experienced tumor recurrence. Among the other seven cases with multiple lesions, only one patient with disseminated lesions died due to disease burden. Five patients with multiple lesions received cisplatin-based intravenous or intraperitoneal chemotherapy, with a mix of complete (n= 2) and partial (n= 2) responses observed. Of particular note, one patient receiving cisplatin and pemetrexed combination chemotherapy experienced complete tumor resolution without any serious toxicity.
We recommend different treatment strategies based on the disease status. If the tumor is completely resectable, an excisional biopsy seems to be sufficient. If complete resection is unavailable for the asymptomatic patient with a localized tumor extent, close follow-up is an appropriate option. When the tumor is extensive or accompanied by symptoms, chemotherapy should be strongly considered.