Malignant mesothelioma of the pleura. A prospective therapeutic study of 132 patients from 1981-1985.

Between March 1981 and February 1985, 93 out of 132 patients with a histologically confirmed diagnosis of malignant pleural mesothelioma were eligible for therapy and were prospectively assigned to receive either combined therapy or best supportive care, according to their personal preferences. Fifty-seven patients underwent multimodal therapy including surgical resection where possible, polychemotherapy, and radiation therapy in case of partial remission. Thirty-six patients received maximal supportive care only, as did 39 patients who were not eligible for treatment. The median survival was 13 months for treated patients compared to 7 for those receiving best supportive care and 5 for patients not amenable to treatment. Median progress-free survival was 6, 2, and 1 month respectively. Surgical resection did not prolong life expectancy within the treated group. In view of significant differences in the distribution of various cofactors over the two study groups, stepwise Cox model analyses were performed. Prognostic nontreatment variables related to prolonged survival were: good performance status, stage I and II, absence of chest pain, age below 50 years, and epithelial histology. Although in the Cox model analyses the survival improvement of patients being treated could be greatly attributed to other cofactors, multimodal treatment showed some prolongation of life expectancy.