Population-based Epidemiology and Prognosis of Mesothelioma Defined
Researchers from Leeds in the UK have reported that the incidence of mesothelioma is increasing and that the prognosis is worse than ascertained in selected studies from referral institutions. The details of this study appeared in an early online publication in Thorax on January 17, 2008.1
Most of the recent publications concerning malignant mesothelioma involve clinical trials of palliative chemotherapy carried out in referral centers. However, the demographics of such referral patients may not represent the entire population of patients presenting with mesothelioma in the community at large.
The current study looked at all the patients with mesothelioma in a population of 750,000 during a four-year period between 2001 and 2005. These authors identified 146 cases of mesothelioma with the following characteristics:
* 77% were male, and the median age was 74 years (36-93).
* 63% had a performance status of 2 or better at diagnosis.
* The median survival from diagnosis was nine months.
* 75% of patients had symptomatic pleural effusion at the time of diagnosis.
* 42 patients had a surgical resection with a recurrence rate of 14%.
* 73 patients received radiation therapy.
* Seven patients, six of whom had received radiation therapy, developed biopsy tract invasion.
* 54 patients were considered eligible for chemotherapy but 28 declined treatment.
* Overall entry into a clinical trial or treatment with chemotherapy was 18%.
These authors suggested that patients with mesothelioma were presenting at an older age with worse performance scores than previously reported. They suggested that 37% were suitable for palliative chemotherapy but less than 20% accepted. They suggested that thorascopic pleurodesis was associated with a relatively low recurrence rate. Radiation did not appear to prevent biopsy tract recurrence.
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