Bidirectional chemotherapy allowing surgery and HIPEC for malignant peritoneal mesothelioma

BACKGROUND: This case report aims to describe the impact of the bidirectional chemotherapy (BDC) on resecability for initially unresectable malignant peritoneal mesothelioma (MPM). METHODS: We report a case of 55-year-old male with the diagnosis of initially unresecable MPM. The BDC combined intravenous (IV) chemotherapy (Cisplatin–Pemetrexed) and intra peritoneal (IP) chemotherapy (Cisplatin). The response to chemotherapy was assessed by CT – scan and laparoscopy. RESULTS: Initial evaluation classed the disease as unresecable with PCI at 39. At the reevaluation, CT – scan and laparoscopy showed a macroscopic response, allowing surgery consisting of cytoreductive surgery and hyperthermic intra peritoneal chemotherapy (Doxorubicin and Cisplatin). CONCLUSIONS: BDC (IV and IP) has promising results and allows to undergo surgery for selected patients with borderline or initially unresectable MPM.