Malignant pleural mesotheliomas.

An increase in incidence of malignant pleural mesotheliomas has been noted recently. In order to assess our own experience, we reviewed all medical re cords and biopsies of patients who were seen with this diagnosis in Hospita l Maria Ferrer between January 1986 and December 1997. Clinical data of 17 patients were analyzed. Mean age was 59 years, 76% were male. Industrial or environmental exposure to asbestos was established in 9 patients (53%). Mo st common symptoms at presentation were dyspnea (88%) and chest pain (65%). Pleural thickening with or without effusion was the usual finding in chest X rays and CAT scans. Biochemical analysis of pleural fluids was consisten t with exudate. Diagnosis was performed by thoracotomy (47%), needle biopsy (23.5%) and videothoracoscopy (29.5%). Histological samples were available for review in 16 of the 17 patients: they were epithelial (10), sarcomatoi d (2) and mixed tumors (4). Treatment reflected varying approaches. Palliat ive methods (pleurodesis, chemotherapy and radiotherapy) were preferred at the beginning while more aggressive interventions are performed nowadays. P leuroneumonectomy alone or in combination with other therapies was carried out in 5 patients with no operative mortality although some complications o ccurred such as empyema, bronchopleural fistula and severe chest pain. Surv ival rate for all groups was 10.5 +/- 5.9 months. However, the mean surviva l of patients who underwent surgery was 17.5 +/- 2.1 months (p<0.04) with a n associated improvement in quality of life. Therefore, we consider that su rgery associated with other therapies offers at present, the best therapeut ic option for this bad prognosis condition.