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First national MDT for peritoneal mesothelioma

Basingstoke and North Hampshire Hospital and The Christie Hospital, Manchester were originally designated as national centres for the assessment and management of PseudomyxomaPeritonei (PMP) in April 2000. 

PMP is a rare malignancy arising mainly from the appendix which spreads throughout the peritoneal cavity producing a large amount of mucus. Complete Cytoreduction, an innovative surgical technique, used to treat patients with PMP was developed by Paul Sugarbaker at the Washington Cancer Institute. It involves surgical removal of tumour by a combination of peritonectomies (removing the lining of the abdomen) and removal of affected organs, combined with heated intraperitoneal chemotherapy (HIPEC).

At Basingstoke and North Hampshire Hospital, the same treatment has been used for patients suffering from the rarer condition of peritoneal abdominal mesothelioma with collaboration with centres abroad collecting outcomes in an international registry.

Patients may benefit from surgery if all their macroscopic disease can be completely removed and the abdomen washed with hot chemotherapy. Sometimes if there is a lot of abdominal swelling from ascites with disease on the omentum, a major tumour debulkingprocedure can help control symptoms and improve quality of life.

Unfortunately, the majority of patients are not suitable for this approach and are best treated with systemic chemotherapy. We use combination of CT scans and keyhole laparoscopy procedures to help select those who may benefit.

In July 2015, NHS England concluded there was insufficient evidence of the effectiveness of this treatment for patients with abdominal mesothelioma and so this treatment iscurrently not routinely funded by the NHS.

Basingstoke & North Hampshire Hospital is working with The Christie, Manchester, Good Hope Hospital in Birmingham and The Mater Hospital, Dublin and have set up a National Peritoneal Mesothelioma Multi-Disciplinary Team (NPMMDT), bringing together leading clinical specialists to discuss every referred patient, focusing on their presentation, diagnosis and treatment options and providing recommendations.

The team aims to gain consensus on clinical approach and to gather evidence on the effectiveness of NPMMDT outcomes and surgical treatment, to support NHS England in its commissioning decisions.

The team first met in July 2016 and have held six subsequent National Peritoneal Mesothelioma MDT meetings, discussing 49 patients and making recommendations as to most appropriate treatment. The NPMMDT has recommended four patients for surgery and others for chemotherapy in the first instance, with possible surgery as a subsequent treatment option.

We are seeing a growing number of referrals to the National Peritoneal Mesothelioma MDT and we anticipate making treatment recommendations for over 100 patients a year initially and crucially, collate the outcomes of any treatment provided.