A succesfull case of HIPEC in a peritoneal mesothelioma patient

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1 A succesfull case of HIPEC in a peritoneal mesothelioma patient Firmino, NLJ¹²; Miranda, E¹³; Oliveira, DA ²; Lima, MBA ¹²; Diniz, AF ¹²; Gomes, GES ¹²; Azevedo, LW ¹²; Soares,MC¹²; Gomes, ASA³. ¹Pernambuco University, Recife, Brazil. ²LOPE Liga de Oncologia de Pernambuco, Recife, Brazil. ³UNIONCO - Surgical and Clinical Oncology Institute, Recife, Brazil.

2 INTRODUCTION Peritoneal mesothelioma is a rare disease with around 250 cases per year in the US. There will be an annual mortality of 5-10 % until This disease also is interesting due to occupational and medicolegal implications related to its occurrence. Exposure to asbestos is the main cause related to this cancer and it is estimated that at least 8 million people were exposed to this substance in the last 50 years in the United States of América. Conventional treatments, including intraperitoneal catheter chemotherapy proved to be ineffective.

3 CASE REPORT A 52 years old patient with postprandial fullness with 12 months of evolution underwent investigation. Exams showed an elevation of CA125 and ultrasound showing slight ascites. Magnetic resonance imaging of the abdomen showed "moderate diffusely distributed ascites. No solid lesions were found. Patient was submitted to systemic chemotherapy with Cisplatin and Pemetrexed. Submitted to videloaparoscopy on June/2014 with findings of numerous nodules in parietal peritoneum with about 1 cm and diffusely scattered. Biopsy of the parietal peritoneum: epithelioid malignant mesothelioma. IHC: Calretinin, CK7 positive WT-1 and CK20 and negative PAX8, consistent with epithelial mesothelioma epithelioid. On January/2015 was submitted to HIPEC surgery with full parietal peritonectomy and histerectomy. HIPEC was performed with Cisplatin 50 mg/m2 and Adriamycin 15 mg/m2 to 42 C for 60 minutes. Total duration of HIPEC: 9h 30min. Patient is now witout ecidence of disease living a normal life.

4 DISCUSSION Malignant mesothelioma (MM) arising in the peritoneal cavity is a rare neoplasm characterized by peritoneal progression and for which there are limited therapeutic options. Surgical resection and HIPEC has been favorable outcome is associated with age, tumor biology (selection of patients with a history of previous debulking), lack of invasive tumor growth, and minimal residual disease after tumor resection. A study showed that women had more favorable histopathologic features, which might contribute to their better survival. The recognition that surgery alone may not provide adequate local disease control has provided the rationale for combining CRS with HIPEC. Chemotherapy is administered intraoperatively to allow direct chemotherapy and tumor-cell contact and to minimize systemic toxicity Hyperthermia has had direct cytotoxic effects in both temperature and time-dependent manners. Heat increases the depth of penetration of chemotherapy and synergizes the cytotoxic drugs selected for intraperitoneal use at the time of surgery. CRS combined with HIPEC has showed promising results, a prospective comparison of HIPEC versus no HIPEC is not available. Also, no definitive information concerning optimal choice of chemotherapy agents in HIPEC exists.

5 References 1. Feldman, Andrew L., et al. "Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy." Journal of Clinical Oncology21.24 (2003): Yan, Tristan D., et al. "Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience." Journal of Clinical Oncology (2009): Contato: Nildevande Firmino L. Júnior - Recife (PE) Universidade de Pernambuco Liga de Oncologia de Pernambuco