[Epidemiology of malignant pleural mesothelioma in the Nantes-Saint Nazaire region. Course in 1956-1992]. / Epidémiologie du mésothéliome pleural malin dans la région de Nantes-Saint Nazaire. Evolution 1956-1992.

The aim of this study was to estimate the evolution of the incidence of mesothelioma in the Loire-Atlantique department since 1956 and to register all the cases diagnosed between 1985 and 1992 and to complete the data of earlier studies carried out between 1956 and 1984. The cases were indexed from the files of the pathology department and also from demographic and occupational data concerning the patients which had been gathered retrospectively from an inquiry of patients attached either to private physicians or to a hospital service. From 1956 to 1984 there were 125 cases (119 men, 6 women) who had been diagnosed; 92 cases were registered between 1985 and 1992 (79 men and 13 women). An increase in the annual number of cases was significant. The incidence during the period 1985-1992 was 10.9 per million inhabitants (men 19.4, women 3) against 8.7 (men 17.2, women 0.8) for the period 1975 to 1984 and 2.6 (men 5.2, women 0.2) for the period 1956-1974. The mean age of the subjects at the time of diagnosis rose during the period studied (59.2 +/- 9.4 between 1956-1974 to 63.1 +/- 11.9 between 1975-1984 and 67.0 +/- 9.7 between 1985-1992). Occupational exposure to asbestos was certain or probable in 85 per cent of cases with a median duration of exposure of 25 years (range 2 months to 48 years) with a median interval between the first exposure to diagnosis of 44 years (range 10-70 years). The industrial sector most often implicated was naval construction (127 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients.

The existence of large shipyards accounts for the particular frequency of pleural mesothelioma in the Nantes-St. Nazaire region of France. From 1955 to 1985, 167 cases were diagnosed. Occupational exposure to asbestos was involved in 131 cases (88 percent). There was a great predominance of epithelial types (135) over mixed (25) and fibrosarcomatous (7) types. Survival, estimated by the actuarial method, was 54 percent at one year from first symptoms and 39 percent from histologic diagnosis. No subject was alive four years after diagnosis. Histologic type and asbestos exposure had no predictive value in our series. Survival was longer in patients under 60 years of age and when mesothelioma originated on the left side. Overall, treated patients had significantly longer survival than untreated patients. However, there was no significant difference in survival with respect to the type of treatment given: surgery, chemotherapy, talc poudrage or their combination.

[The value of computed tomography in the assessment of thoracic mesothelioma (author's transl)]. / Intérêt de la tomodensitométrie dans l'évaluation des mésothéliomes thoraciques.

The authors report their experiences with computed tomography (CT) in 17 patients suffering from histologically proven pleural mesothelioma. The examination has two particular values. First the extent of the lesions can be assessed, in particular the retraction of the hemithorax, the detection of mediastinal involvement (which would be invisible to all other methods of examination including thoracoscopy), the exploration of the adjacent lung and the fissures, as well as the diaphragm. Secondly CT appears to be the only objective and reproducibly examination for the surveillance of lesions under treatment.

[Evolutive patterns of diffuse pleural mesothelioma (author's transl)]. / Aspects évolutifs des mésothéliomes pleuraux diffus.

The clinical beginning of diffuse pleural mesothelioma is a pleurisy. Initially pleura may be normal at X-ray examination, then either a pachypleuritis or a tumorous pleura appears. Thery serious since there is in the literature no cured case. The average survival time from diagnosis to death is 15 months. At terminal stage mesothelioma does not invade the other coelomic cavities. It may remain limited to the hemithorax where it has started, invading then the organs by contiguity. Metastasis may occur but their frequency is very variable, from 30 to 70% according the literature. On a therapeutic point of view all was tried: Surgery is rarely curative but may reduce temporarily effusion pain and dyspnea. Radiotherapy at high doses produces a partial effect in some series, but results are variable. Chemotherapy: adriamycin could be the most promising agent. At present time according to many authors no treatment seems to change the course of the disease.