Between 1969 and 1985, 245 patients with diffuse malignant mesothelioma were treated (157 male, 88 female). The average age was 55.8 years and the sex ratio was 1.8:1 in favour of males. The right side was more frequently affected than the left (56.7% vs. 43.3%). A pleural effusion and dyspnoea were the presenting signs and symptoms in 83.7% of the patients and unilateral chest pain in 64.2%. Noninvasive diagnostic procedures included a chest X-ray and computed tomography of the thorax. Pleural effusion and pleural thickening were detected most frequently. Malignant cells were identified by pleural fluid cytology in 45.3% and by needle biopsy of the pleura in 42.7% of the patients. Forty-five patients were treated conservatively and 200 patients underwent operation: diagnostic thoracotomy (78); partial pleurectomy (72); total pleurectomy (46); extended pleuropneumonectomy (2); partial removal of the diaphragm (1) and total pleurectomy and upper lobectomy (1). The perioperative mortality was 6%. The conservative and postoperative treatment depended on the patients' symptoms and included radiotherapy and chemotherapy alone or in combination. The mean survival time of the 222 non-survivors was 9.2 months. After 1 year, 36% of the patients were still alive, after 2 years, 10.8% and the 5-year survival was 4.1%. The median survival time in patients treated non-operatively was 6 months--a little over half that of the patients treated surgically (10.1 months).
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