Peritoneal mesothelioma: Treatment approach based on natural history

Peritoneal mesothelioma is a rare tumor that is considered a terminal disease with only palliative treatment options. The natural history and actual incidence of disease are poorly documented because most reports include pleural and peritoneal mesothelioma together as a single disease. The estimated incidence of both pleural and peritoneal mesothelioma in the United States in 1975 was 2.2 cases per million population [1]. According to the experience at the University of Minnesota, the incidence of the disease has been on the rise in last few decades, probably due to more precise diagnosis [2]. Now it would be reasonable to estimate that 2,200 new cases (range 1,000–3,000+) of mesothelioma occur in the United States annually [3]. In most reports peritoneal and pleural mesotheliomas are considered as a single entity. Pleural mesothelioma is encountered more often and constitutes 60–90 percent of all cases [4,5]. Nevertheless, it has been reported that the natural history and prognosis of peritoneal and pleural mesotheliomas differ somewhat. Antman and colleagues [4,5] suggested that patients with peritoneal mesothelioma survive better. At autopsy tumor remained confined to the abdomen in two thirds of the cases and in 78 percent of them death was a direct result of complications of intraabdominal disease.