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Malignant mesothelioma arises from the serosal lining of the pleural, peritoneal, and pericardial cavities.1–6 It is a rare neoplasm and has been implicated to be associated with asbestos exposure.1–5 The rising worldwide incidence of malignant mesothelioma is not expected to peak for another 10–20 years.5 Diffuse malignant peritoneal mesothelioma (DMPM) represents one-quarter of all mesotheliomas with an annual incidence of DMPM of 300–400 cases in the US.2-3 It is characterized macroscopically by thousands of whitish tumor nodules of variable size and consistency that may coalesce to form plaques or masses, or layer out to uniformly cover the entire peritoneal surface. Although association of asbestos exposure with DMPM has been observed, the pathogenesis of this disease is largely unknown.7-8
In addition, DMPM has been reported following radiation therapy, mica exposure, recurrent peritonitis, and administration of thorium dioxide.9–13

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A great majority of patients present with abdominal pain and distension caused by the accumulation of tumors and ascitic fluid.14Without aggressive treatments the disease is rapidly fatal.15 In the past, DMPM was treated at most cancer centers with a combination of systemic chemotherapy, palliative surgery, and, in a few patients, total abdominal radiation. However, the patients did not seem to respond to these treatments in that the median survival was approximately one year (see Table 1).16–22 No randomized trials have been attempted but it is likely that the survival associated with these palliative treatments was little different from the natural course of the disease.

benign mesothelioma, mesothelioma patients, mesothelioma, mesothelioma lawyers san diego

In most patients DMPM remains localized within the abdominopelvic cavity throughout its course. An aggressive treatment plan to surgically eradicate gross disease combined with peri-operative intraperitoneal chemotherapy (PIC) to control residual disease has a strong locoregional treatment rationale.23–25 This combined modality has been used with success in patients with pseudomyxoma peritonei and peritoneal carcinomatosis from other gastrointestinal and gynecologic malignancies.26–31 Treatment of peritoneal carcinomatosis through the use of intraperitoneal chemotherapy was declared standard of practice by the National Cancer Institute, Bethesda, US after a recent phase III study in ovarian cancer.32 Especially in the last five years, as the cytoreductive surgical (CRS) approach combined with PIC was expanded, the results of treatment for DMPM have dramatically improved compared with historical controls.The median survival has approached five years.14,33–49

benign mesothelioma, mesothelioma patients, mesothelioma, mesothelioma lawyers san diego