Malignant mesothelioma: A ten years experience
Revista Portuguesa de Pneumologia. 2005 Nov-Dec;11(6 Suppl 1):16-8. [Link]
C L, R SM, E T, A A.
Servico de Pneumologia, Hospital de Santa Maria, Lisboa.
Introduction: Malignant mesothelioma (MM) is a rare neoplasm arising from mesothelial cells. Most common location is the pleura followed by the peritoneum.
Aim: Evaluate the clinical characteristics, therapy regimens and survival of mesothelioma patients, observed in our Department, between January 1995 and August 2005.
Population and methods: We retrospectively reviewed the clinical files of all mesothelioma patients observed in our Pulmonology Oncologic Unit between January 1995 and August 2005 . We evaluated clinical characteristics, diagnostic methods, clinical staging at diagnosis, performance status (ECOG), management and outcomes.
Results: Clinical files from 15 mesothelioma patients were reviewed, 14 were males. The median age at diagnosis was 61 years (range 47-78). Histologicaly, the epithelial type was the most frequent – 7 cases (47%). Occupational exposure to asbestos was identified in 10 patients. Nine patients had current or former smoking habits. The most common presenting symptom was chest pain (10), followed by dyspnoea (9) and cough (4). Two were asymptomatic – pulmonary nodule and pleural effusion found on routine chest x-ray. One single patient presented with vascular thrombosis. Pleural effusion (14) along with pleural plaques (9) were the most common imagiologic findings. Right pleura was mostly affected (10). In every case, the diagnosis was made by pleural biopsy; obtained through thoracoscopy (6), thoracotomy (3), thoracocentesis (3) and transthoracic needle aspiration (1). Pathologic staging at diagnosis revealed: stage IV (8), stage II (4) and stage I (3). Twelve patients had performance status (ECOG) 1 at diagnosis. Four patients (stage I-II) underwent surgery: left pleuropneumectomy (1) and tumoral excision with parietal pleurectomy (3). Nine patients received chemotherapy alone: gemcitabine+platinum agent in eight patients, and pemetrexed+carboplatinum in another, as first line regimens. In four of these patients, a second line regimen, including pemetrexed, was administered. Palliative radiotherapy was given in 2 cases. Eight patients underwent pleurodesis because of recurrent pleural effusion, four with talc and one with nitrogen mustard. Talc pleurodesis performed by thoracoscopy achieved better results than chest drainage approach. The median survival time after diagnosis was 22 months (4-57). In patients who received combined chemotherapy and talc pleurodesis the median survival was 44 months (13-57 months).
Discussion: As demonstrated by the small series in ten years, malignant mesothelioma is a rare tumour. Relationship with asbestos exposure was proven in 67% of cases. Chemotherapy associated with talc pleurodesis increased survival and palliated symptoms.