Malignant pleural mesothelioma. A clinical review of 19 patients

A retrospective study is presented of 19 patients with pleural mesothelioma diagnosed over an 18-year period (1964-1981). Two patients are alive after observation for 12 and 16 months. In 16 fatal cases the post-diagnosis survival time was 1-113 (median 17) months. One patient was lost to follow-up after 6 months. The male: female ratio was 5.3:1. The disease was most commonly detected in persons in their sixties and seventies. Pain and dyspnoea, the most common of the presenting symptoms, occurred in half of the patients. Weight loss and malaise were reported by six patients. Mesothelioma was most common on the right side, but often spread to the left, infiltrating the pericardium and the diaphragm. Metastases to abdominal organs were found in five of the eight autopsies, and in three other patients there were clinical signs of abdominal spread. Thoracotomy was performed in 12 patients, in one of whom radical removal of the tumor was attempted, but the patient died of recurrent tumor. Radiotherapy and cytostatic medication had no demonstrable effect on survival. Pleural effusion developed in all cases and all had roentgenologically demonstrated changes. Exposure to asbestos was documented in 6 of the 19 cases. In three asymptomatic patients the mesothelioma was incidentally revealed by routine X-ray examination, and these patients had significantly longer survival than the others. One of these tumors, however, had a relatively benign histologic appearance. Frequent X-ray examination of risk groups seems to offer the only prospect of improving management by earlier diagnosis.