Malignant pleural mesothelioma stage III and IV: Retrospective analysis of ten years in a central hospital

Introduction: Pleural mesothelioma (PM) is the most frequent malignant primary tumor of pleura. The incidence in Western Europe is still rising due to the prolonged latency of the disease. Aims: Determine demographic, epidemiological, histological and therapeutical aspects of malignant PM in stage III and IV. Evaluate survival rates. Methods: The study was conducted in an European central hospital covering approximately 475.000 inhabitants. We performed a retrospective analysis of cases diagnosed in our department over a period of 10 years. Survival analysis was performed using Kaplan Meier method and Cox regression. Results: We diagnosed 32 cases in stages III/IV (91,5% of total), 84.4% men, mean age 65.5+-10.2 years, 50% with current or past exposure to tobacco. Exposure to asbestos was reported in 56.3% and had occurred, on average, 41.4+-10.8 years before. Approximately 56% of exposures were associated with building construction and mechanics. In 87.5% the diagnosis was obtained with video-assisted thoracic surgery. Histology was epithelioid in 84%. All patients received chemotherapy: 53.1% carboplatin+gemcitabine, 37.5% pemetrexed+cisplatin and 9.4% cisplatin+gemcitabine. Hematological toxicity occurred in 18.8% and non haematological toxicity in 12.5% (grade 3/4). Prophylactic local radiotherapy was performed in 75%. Median survival was 51.6+-9.4 weeks. There was no statistically significant difference according to chemotherapy regimen. Conclusion: Malignant PM must be considered, particularly in men involved in mechanics, even with unrecognized or remote exposure to asbestos. In our series no difference was seen combining platinum analogs with gemcitabine or pemetrexed.