Malignant pleural mesothelioma (MPM) – 5 years of experience
Revista Portuguesa de Pneumologia. 2005 Nov;11(6 Suppl 1):15-6. [Link]
Vieira J, Nogueira C, Barroso A, Conde S, Parente B.
Unidade Pneumologia Oncologica. Centro Hospitalar de Vila Nova de Gaia.
Introdution: Despite all data available regarding Surgery (S), Radiotherapy (Rt) and Chemotherapy (Ct), the best approach in MPM treatment is not well-defined. Radical Rt is associated with severe complications and only a few number of patients have surgical indication once most of the them have local advanced disease, old age and comorbilities. Qt is often the only hope. Because MPM is a rare neoplasm, most of the existing series include a small number of patients and few essays have been randomized.
Objectives: To review the institution experience, regarding the therapeutic methodology according to the stage of disease and evaluate the survival according to the histological type. Professional aspects and residence area were also taken into account.
Material and methods: In the period between 2000 and 2005, 18 patients with MPM were observed, 7 to initiate treatment and 11 to diagnosis and treatment. Only 14 patients continued treatment in this Hospital.
Results: Male was prevalent (66.6%), with an average of 64.1 years of age (max-80; min-48). Most of the patients lived in Porto (61%) and Guarda (22%). Exposure to asbestos fibres- 4 patients, all cases with a latency period of more than 25 years.
Diagnosis: Thoracoscopy- 10; transthoracic aspiration biopsy- 4; thoracotomy- 2; pleural biopsy- 1 patient. The prevalent histological type was the epitelial mesothelioma (16 patients). Stage: Stage IV- 3 patients: 2- Rt+Ct;1 to continue treatment. Stage III- 10 patients: 5- Rt+ Ct; 1- S + Rt+Ct; 2 para Rt. Stage II- 1 patient- Rt+Ct,without surgery indication. Stage I- 4 patients (2- IA; 2- IB): 1- C+Rt+Qt; 3- Rt +Qt without surgery indication. In all patients submitted to Ct, Carboplatinum+Gencitabin were the first line drugs used except in 1 patient (Alinta+Gencitabin). Evolution (14): 8 died- Overall survival 18.75 months (max-60; min-1); 6 alive( 4 stabilized,1 in partial remission and 1 in progressive disease).
Discussion: S rarely is the treatment of choice, once most of the patients have local advanced disease, old age and comorbilities. The epithelium mesothelioma was the prevalent histological type and because of the few number of patients with other types, it was not possible to establish significant relationships between the histological type and the overall survival. The survival tends to increase, 3 patients were treated with second line Ct and 1 with third line Ct.