Malignant mesothelioma: diagnostic and management strategies for 1992

Malignant mesothelioma of the pleural and peritoneal surfaces is epidemiologically linked to crocidolite, a long, thin, and rigid form of asbestos whose use has been dramatically curtailed within the past 20 to 25 years. The incidence of disease may have peaked around 1984 and may now be declining. The highest incidence of disease occurs in elderly white men (greater than or equal to 75 years old). The histology of mesothelioma is classically biphasic, with both epithelioid and sarcomatous areas present. Independent pathologic review can be useful, and a variety of special stains should be used, if diagnosis is unclear. Electron microscopy and serum carcinoembryonic antigen levels are also useful. Surgical treatments have been difficult, but 3-year survival rates range from 15% to 36%. Unfortunately, only about 20% of all diagnosed patients are candidates for aggressive surgical approaches. Radiotherapy likewise has been disappointing, although occasionally useful. Lastly, 13 single-agent chemotherapy trials conducted on 302 patients using 10 different commercially available drugs have failed to identify a consistently effective agent. Combination chemotherapy has also not proven effective and, therefore innovative new approaches are needed.