Treatment results of 17 patients with diffuse pleural mesothelioma

Treatment for diffuse pleural mesothelioma is very difficult. A retrospective study is established for analyzing the experiences in management of such a rare but fatal disease. From May 1960 to August 1996, 17 patients underwent treatment for pathologically confirmed malignant pleural mesothelioma at Veteran General Hospital-Taipei. The chart records were carefully reviewed and surgical specimens were reconfirmed by the pathologist. Single or combined treatment protocols with surgery, chemotherapy, and radiotherapy had been used according to the clinical situation. Pathological staging was recorded according to the Butchart staging system. Gender, smoking, asbestos exposure, histology, and survival were analyzed. There were 17 patients in total, including 15 males and 2 females with a mean age of 62 years. The most common symptoms were chest pain, cough, dyspnea and weight loss. For getting definite pathological diagnosis, the most sensitive procedures were video-assisted thoracic biopsy and open lung biopsy. In spite of trying multiple different treatment protocols, disease staging ( p = 0.0186) and the epithelial pathological type ( p = 0.0353) were the significant prognostic factors in our series. Prognosis of diffuse pleural mesothelioma is very poor. It was predominant in nen and no definite relationship with smoking or asbestos exposure was noted in our series, but it was relatively better in patients with early-stage and epithelial-type disease. Further efforts to improve the survival should be delivered on more aggressive cytoreductive surgery with early postoperative concurrent chemo-radiotherapy.