Original Title: Pertinence de la chimiothérapie intrapéritonéale pour prévenir ou traiter les néoplasies des surfaces péritonéales : Mésothéliome péritonéal

Authors' objectives: the Direction de la cancérologie of the ministère de la Santé et des Services sociaux (MSSS) has mandated the Institut national d’excellence en santé et en services sociaux (INESSS) to assess the clinical relevance of intraperitoneal chemotherapy for the prevention or treatment of peritoneal surface neoplasms and to issue recommendations, where appropriate, to support its optimal, equitable, and harmonized use across the Quebec healthcare network.

Authors' results and conclusions: RESULTS (#1 HEALTH NEEDS): The median overall survival for people with peritoneal mesothelioma, regardless of histological subtype or treatment administered, is 19.5 months. Epithelioid histology is a predictive factor associated with a better prognosis. (#2 ASSESSMENT OF THE LEVEL OF SCIENTIFIC EVIDENCE): The level of evidence regarding the efficacy and safety of HIPEC in combination with cytoreductive surgery was deemed low and insufficient, respectively. (#3 EFFICACY AND ET SAFETY): The available data do not allow for a comparison of the safety of HIPEC combined with cytoreductive surgery to that of cytoreductive surgery alone. However, some of the evidence reviewed indicates that the procedure carries significant risks of complications for the patient. (#4 PERSPECTIVE IN THE QUEBEC CONTEXT): The consulted clinicians believe that HIPEC should be considered after complete/optimal cytoreduction, despite the low level of evidence, due to the rarity of the disease—which limits the ability to conduct comparative studies—its poor prognosis, and the perceived curative potential of the intervention for certain selected patients. (#5 ENVIRONMENTAL CONSIDERATIONS): The available data on the environmental impacts of HIPEC remain very limited. To date, no life-cycle analysis of HIPEC in a hospital setting comparable to that of Quebec has been identified.

Authors' recommendations: For individuals with resectable peritoneal mesothelioma, the evidence is currently insufficient to determine the efficacy and safety of HIPEC following complete/optimal resection, as well as the quality of life of those who have undergone the procedure. Additional evidence is needed to take a position on the relevance of using the procedure, to specify the optimal modalities of use, and to identify individuals likely to benefit from it (if applicable).

Authors' methods: A systematic review of the scientific literature was conducted to identify available data regarding the clinical relevance of IP chemotherapy combined with cytoreductive surgery (CRS) for the management of peritoneal mesothelioma. The selected literature includes two retrospective studies meeting the selection criteria and nine additional retrospective studies, as well as international recommendations from clinical practice guidelines, expert group publications, and health technology assessment reports (12 publications from 9 different organizations).

Authors' identified further research: The relevance of updating this opinion will be assessed and determined based on the availability of new data supporting any of the evaluated aspects, in particular the publication of studies, meta-analyses, recommendations from international organizations, or national regulations.

Project Status: Completed

Year Published: 2026

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Oncologie/CHIP_Mesotheliome_peritoneal_avis.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)