5. Regarding the beginning of chemotherapy intraperitoneal post: Two groups lawyer Taxol (Cancer Institute in Washington) or Taxol plus 5-fluorouracil (Naitonal Cancer Institute, USA) in the early postoperative period with a long residence time of these drugs . At the National Cancer Institute, 125 mg/m2 paclitaxel and 800 mg/m2 of 5-fluorouracil is administered in a single instillation. At the Cancer Institute of Washington, 20 mg/m2/day x 5 days (100 mg/m2) paclitaxel is used.
6. Regarding chemotherapy interval: Mesothelioma Columbia Centre uses multiple cycles of more than 6 months period of more intraperitoneal cisplatin or cisplatin and doxorubicin mitomycin C. The Cancer Institute Washington uses multiple cycles of intraperitoneal paclitaxel with systemic cisplatin (bidirectional chemotherapy) for the treatment of these patients. Currently, treatment plans using intraperitoneal pemetrexed and systemic cisplatin have been involved at various institutions. The success with two-way (through intravenous and intraperitoneal) chemotherapy which has recently been reported for patients with ovarian cancer must be directly applicable to patients peritoneal mesothelioma.
The role of systemic chemotherapy with pemetrexed and cisplatin has not yet been determined after combination therapy. Currently, it is often used in this group of patients, especially those who have aggressive disease and a sub-cytoreduction.
7. Regarding interval or symptomatic second look surgery: At the Cancer Institute Washington symptomatic a second glance is used in patients with the first evidence of recurrence. With symptomatic of second glance, intraperitoneal heated chemotherapy is again used. A change in chemotherapy solution should be considered. The results of treating patients using either symptomatic or interval second review was thought to be improved.
8. Regarding monitoring and identification of patients with recurrent disease for a possible second symptomatic look: The CA-125 tumor biomarkers is proposed under the monitoring of these patients. The gradual increase in the AC-125 was identified as a periodic signal of the disease by the National Cancer Institute of Italy. CT oral and intravenous contrast is a valuable tool for monitoring this group of patients. MRI is not thought to be of value. PET scanner is proposed as a new tool to be studied in this group of patients. PET May be most useful when readings go from negative to positive, which would strongly suggest progressive disease. Reoperation for a low volume of the disease is regarded as a potential part of the standard of care clinical pathway.
9. Regarding the use of intraperitoneal chemotherapy to overcome large volume of ascites: All agreed that patients with ascites debilitating peritoneal mesothelioma respond well to surgery debulking more heated intraperitoneal chemotherapy. The use of mechanical and chemical cytoreduction could be regarded as a benchmark for palliative care for the management of patients with debilitating ascites.
6. Regarding chemotherapy interval: Mesothelioma Columbia Centre uses multiple cycles of more than 6 months period of more intraperitoneal cisplatin or cisplatin and doxorubicin mitomycin C. The Cancer Institute Washington uses multiple cycles of intraperitoneal paclitaxel with systemic cisplatin (bidirectional chemotherapy) for the treatment of these patients. Currently, treatment plans using intraperitoneal pemetrexed and systemic cisplatin have been involved at various institutions. The success with two-way (through intravenous and intraperitoneal) chemotherapy which has recently been reported for patients with ovarian cancer must be directly applicable to patients peritoneal mesothelioma.
The role of systemic chemotherapy with pemetrexed and cisplatin has not yet been determined after combination therapy. Currently, it is often used in this group of patients, especially those who have aggressive disease and a sub-cytoreduction.
7. Regarding interval or symptomatic second look surgery: At the Cancer Institute Washington symptomatic a second glance is used in patients with the first evidence of recurrence. With symptomatic of second glance, intraperitoneal heated chemotherapy is again used. A change in chemotherapy solution should be considered. The results of treating patients using either symptomatic or interval second review was thought to be improved.
8. Regarding monitoring and identification of patients with recurrent disease for a possible second symptomatic look: The CA-125 tumor biomarkers is proposed under the monitoring of these patients. The gradual increase in the AC-125 was identified as a periodic signal of the disease by the National Cancer Institute of Italy. CT oral and intravenous contrast is a valuable tool for monitoring this group of patients. MRI is not thought to be of value. PET scanner is proposed as a new tool to be studied in this group of patients. PET May be most useful when readings go from negative to positive, which would strongly suggest progressive disease. Reoperation for a low volume of the disease is regarded as a potential part of the standard of care clinical pathway.
9. Regarding the use of intraperitoneal chemotherapy to overcome large volume of ascites: All agreed that patients with ascites debilitating peritoneal mesothelioma respond well to surgery debulking more heated intraperitoneal chemotherapy. The use of mechanical and chemical cytoreduction could be regarded as a benchmark for palliative care for the management of patients with debilitating ascites.
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