Mesothelioma: Current Perspectives

Thirty patients with the diagnosis of mesothelioma were admitted to the Swedish Hospital Medical Center, Seattle, from 1975 to 1979. Of these, 26 had pleural and 4 had peritoneal mesothelioma. In 20 of the patients with pleural mesothelioma, the diagnosis had been made by open thoractomy and in only one by needle biopsy of the pleura. The average survival of the patients with pleural tumors from time of diagnosis was 15 months, and two are alive at three and eight months, respectively, one of whom had an apparent solitary benign mesothelioma. The average survival of those with peritoneal mesothelioma was ten months, although one has survived six years. There were 17 patients with a known history of exposure to asbestos, 14 while working in shipyards. Because of the relatively high incidence of this previously rare tumor in the Puget Sound, Washington, area, and the generally dismal results of therapy, better methods of diagnosis including thoracoscopy and a more systematic approach to treatment are recommended. IN RECENT YEARS, mesothelioma, a tumor of serosal surfaces, has become a subject of growing interest among the medical profession and the lay public. The attention is due both to its increasing frequency of diagnosis and its strong epidemiological link to asbestos exposure.1-7 Asbestos, a mineral fiber, is valued for its thermal properties and has found wide application in this century as an insulating material. Until recently, including the busy years of World War II, it was used extensively in ship building as pipe insulation. Growing evidence indicates that the populations in those areas with ship building activities have a significantly increased risk of developing mesothelioma.' 8 In a tumor registry study by Hinds8 of eight areas of the United States, the Puget From the Department of Surgery, the Swedish Hospital Medical Center, Seattle (Dr. Taylor), and the Department of Sturgery, University of Washington School of Medicine, Seattle (Dr. Johnson). Submitted September 29, 1980. Reprint requests to: Lloyd P. Johnson, MD, Seattle Surgical Group, Inc., P.S., 801 Broadway, Suite 901, Seattle, WA 98122. Sound area and New Orleans, both with substantial shipyard activity, had the highest incidence of mesothelioma. During the past 41/2 years, one registry reported 85 cases of malignant pleural mesothelioma in western Washington (written communication, June 1980, Fred Hutchinson Cancer Research Center, Seattle). Because of this somewhat unusual epidemiology, the apparent increasing incidence of the disease and the generally poor results of therapy, we wish to review our recent experience with mesothelioma and propose some new directions for its diagnosis and management. Clinical Presentation The cases of 30 patients admitted to the Swedish Hospital Medical Center in Seattle between 1975 and 1979 were reviewed. In all of the patients mesothelioma had been diagnosed by tissue analysis. There were 25 with diffuse malignant pleural disease, 4 with peritoneal tumor a