Pleural mesothelioma

Seventy-six patients with pleural mesothelioma were seen at Memorial Hospital from 1939 to 1972. There were 10 with benign and 66 with malignant mesotheliomas. The latter were histologically divided into 39 epithelial and 27 fibrosarcomatous types. Main symptoms were chest pain, dyspnea, and cough. Most of the patients with malignant disease had clinical and radiologic evidence of effusion with or without an intrathoracic mass. Thirty-seven patients had primary untreated mesothelioma and 29 patients had disease that had previously been treated elsewhere. Treatment at Memorial Hospital consisted of surgery, with or without radiation therapy, and supplemental chemotherapy. Survival was related to extent of disease and to treatment. In patients with epithelial mesothelioma confined to the hemithorax, resection was associated with a median survival of 21 months. When irradiation was the primary treatment, the median survival was 8 months. In fibrosarcomatous mesotherlioma, the median survival with resection was 11 months and with radiation, 9 months. Median survival in patients with advanced or recurrent disease was 3 to 6 months. It is concluded that epithelial mesotherlioma with diffused pleural involvement continues to carry a grave prognosis. Better survival is obtained where pleurectomy with resection of the bulk of the tumor is combined with external irradiation and systemic chemotherapy. In fibrosarcomatous mesothelioma, complete resection offers a significant chance of long-term survival. In patients with benign mesothelioma, none had recurrence nor died of disease after adequate resection.