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Yonemura et al. J Cancer Metastasis Treat 2022;8:43 https://dx.doi.org/10.20517/2394-4722.2022.49 Page 9 of 12

Figure 5. Serum CA125, hyaluronic acid, and SMRP levels during nivolumab treatment in a recurrent mesothelioma patient.

[37]
postoperative chemotherapy and no POC .
Kusamura et al. asserted that the benefit of NASC after CRS + HIPEC is uncertain . To verify the role of
[10]
NASC in DMPM patients, prospective randomized trials are mandatory.

CRS + HIPEC is now considered an effective treatment for DMPM patients compared to SC alone.
[10]
Hyperthermia over 43 °C induces irreversible changes in the three-dimensional structure of cellular protein,
and 99% of cells can be killed after 60 min of hyperthermia at 43.5 °C .
[38]
In our experience of 12 DMPM patients treated with the same method, PCI changes were studied before
and one month after laparoscopic HIPEC (LHIPEC). One cycle of LHIPEC reduced PCI from 21.1 ± 11.8 to
16.3 ± 13.1 (P = 0.033).

We treated three patients with WDPPM with LHIPEC alone. All three are alive 10, 3, and 4 years after
LHIPEC. In WDPPM, mesothelioma cells grow diffusely on the peritoneal surface in a single layer with a
low capacity to invade subperitoneal tissue. Accordingly, LHIPEC must be an effective method to treat
WDPPM. However, precise histological examination of multiple sections from resected specimens of
WDPPM may reveal subperitoneal invasion in localized peritoneal regions. In these cases, CRS is
recommended .
[39]
[21]
NIPS is now considered as an effective treatment for PSM . In NIPS, intraperitoneal administration of 40
mg of docetaxel and cisplatin with 500 mL of normal saline is performed on Days 1 and 14, and oral intake
of 60 mg/m of S1 is administered on Days 1-14 . After one week of rest (Days 15-21), NIPS is repeated for
2
[37]
at least three cycles.