New strategies are needed in diffuse malignant mesothelioma

Abstract

Background. Medical records of 50 patients with malignant mesothelioma were reviewed to determine the clinical features and factors influencing survival. Methods. Charts of all patients whose conditions were diagnosed as malignant mesothelioma were abstracted and analyzed by statistical software. Results. The male‐to‐female ratio was 4:l. The age distribution was younger than 45 years of age, 10%; 45–54 years of age, 12%; 55–64 years of age, 37%; 65–74 years of age, 33%; and 75 years of age or older, 8%. Both mean and median ages were 58 years. Among the 32 patients in whom asbestos exposure was recorded, 24 had documented exposure. The sites were pleura, 73%; peritoneum, 20%; and both, 6%. The histologic types were epithelial, 51%; sarcomatous, 10%; mixed, 15%; and not specified, 24%. The stage at presentation was Stage I, 37%; 11, 39%; 111, 12%; IV, 6%; and unknown, 6%. The common symptoms in pleural disease were dyspnea and pain; in peritoneal disease, abdominal distension and pain were common. The median time from first symptom to diagnosis was 3 months (range, 0–23 months). The median survival after the appearance of symptoms, the diagnosis, and the treatment were 13,10, and 8 months, respectively. Conclusions. The survival was independent of age, sex, and smoking behavior. It was longer in patients with earlier‐stage disease, a good performance status, a longer duration of symptoms, an absence of pain, and who were treated with combined surgery and chemotherapy. Chemotherapy using anthracyclines yielded more remissions (9 of 21) than that using nonanthracyclines (0 of 13). The remission rate after primary chemotherapy with anthracyclines (7 of 16) may be higher than in recurrent tumor (2 of 14). In future trials, stratifization into primary chemotherapy and chemotherapy of recurrent cancer is suggested. There is a need for multi technique trials incorporating primary Chemotherapy.

P16 Loss and Mitotic Activity Predict Poor Survival in Patients with Peritoneal Malignant Mesothelioma

“…Of the f2,500 new cases of mesothelioma expected in the United States per year, 25% of those cases will arise in the peritoneum (1). Peritoneal mesothelioma has a historical median survival of <1 year (2). However, a significant proportion of patients survive for extended periods, with intensive therapy (1, 3 -5).…”

Value of serum and effusion fluid CEA levels for distinguishing between diffuse malignant mesothelioma and carcinomatous pleural metastases

“…Immunohistochemical detection of carcinoembryonic antigen (CEA) in tumor biopsy material has been shown to be a valuable diagnostic adjunct, as DMMs, unlike LCs and other carcinomas, express this antigen only rarely (9-11%) [5]. In some cases, however, the only method of obtaining suitable biopsy material is by open thoracotomy [2,6]. Moreover, immunohistochemical examinations are expensive and not generally readily available.…”

Asbestos-induced peritoneal mesothelioma in a construction worker.

“…Until recently, peritoneal mesothelioma was considered incurable, with a median survival of less than 1 year from diagnosis. Several different approaches had been unsuccessfully attempted in the past, including surgery, systemic chemotherapy, whole abdominal irradiation, and intraperitoneal administration of radioisotopes ( 32 P, 198 Au) or antiproliferative drugs (thiotepa, bleomycin) (Antman et al 1983;Sridhar et al 1992). No dominant therapeutic guideline currently exists.…”