Malignant mesothelioma: Epidemiology - diagnosis and treatment results of 46 cases

ABSTRACT

This retrospective study included 46 cases of pathologically proven malignant mesothelioma referred to NEMROCK during the period 1978-1989 inclusive. There was a significant progressive increase in the relative frequency of the disease throughout the study. The median age of the patients [39 years] was strikingly younger than the westerns. Asbestosis was encountered in 50% of the cases. Chest pain and dyspnea were the most frequently encountered symptoms, while constitutional symptoms were seen in 41%. Epithelial subtype was the commonest histopathologic variant [43%]. Only 22% of the cases were diagnosed by one pathological sample while 24% needed more than 3 pathological samples to confirm the diagnosis. The diagnostic accuracy was modest for fluid cytology [21%] and blind needle biopsy while satisfactory results were obtained by C.T. guided biopsy [64%] and thoracotomy [86%]. Ipsilateral volume loss with nodular pleural thickening [predominently basal] were the most common radiological features. C.T. Scan was superior to plain chest films in detecting minimal effusion, pericardial involvement and mediastinal disease. None of the treated patients achieved complete remission by treatment. The response rate was 17% for radiotherapy [12 cases] and 25% for the combination of ifosfamide and adriamycin [20 cases], with a median survival of 14 months and 11 months respectively. By multivariate analysis old age, late stages and bad performance status were significantly associated with poor survival