Diffuse malignant mesothelioma of the pleura--intrapleural treatment with doxorubicin

The diagnosis of diffuse mesothelioma of the pleura means a very bad prognosis. The average survival of our own cases, controlled by autopsy, was 16.4 months (n = 36) for symptomatically treated patients and 16.1 months (n = 26) for those treated with Cyclophosphamide and other cytotoxic drugs. The difference between the two groups is statistically without significance. Doxorubicin was applied in a third group. The drug was applied intrapleurally for cases with pleural fluid in doses of 20 to 30 mg, weekly during the first month of treatment and later on monthly. The effect will be controlled directly and during the continued treatment, using cytological examination of the sediment of the pleural fluid and by simultaneous measurement of the level of hyaluronic acid in the same fluid. The advantages of this method are the small dosage, the possibility of applying over a long time and few side effects. 21 patients were treated: 9 without response, 8 lived for a longer period, 4 patients are still alive. The average survival of all the 21 patients observed is now 25.3 (8-79) months. The difference to an untreated control group of 36 patients is proved as statistical significant in favour of the therapeutic group. Doxorubicin, linked with a really early diagnosis, seems to be a suitable drug for essentially improving the prognosis of disease.