title: The diagnosis, therapy and prognosis of diffuse malignant mesothelioma.
abstract: Between 1969 and 1985, 245 patients with diffuse malignant mesothelioma were treated (157 male, 88 female). The average age was 55.8 years and the sex ratio was 1.8:1 in favour of males. The right side was more frequently affected than the left (56.7% vs. 43.3%). A pleural effusion and dyspnoea were the presenting signs and symptoms in 83.7% of the patients and unilateral chest pain in 64.2%. Noninvasive diagnostic procedures included a chest X-ray and computed tomography of the thorax. Pleural effusion and pleural thickening were detected most frequently. Malignant cells were identified by pleural fluid cytology in 45.3% and by needle biopsy of the pleura in 42.7% of the patients. Forty-five patients were treated conservatively and 200 patients underwent operation: diagnostic thoracotomy (78); partial pleurectomy (72); total pleurectomy (46); extended pleuropneumonectomy (2); partial removal of the diaphragm (1) and total pleurectomy and upper lobectomy (1). The perioperative mortality was 6%. The conservative and postoperative treatment depended on the patients' symptoms and included radiotherapy and chemotherapy alone or in combination. The mean survival time of the 222 non-survivors was 9.2 months. After 1 year, 36% of the patients were still alive, after 2 years, 10.8% and the 5-year survival was 4.1%. The median survival time in patients treated non-operatively was 6 months--a little over half that of the patients treated surgically (10.1 months).
authors.affiliation: Department of Pneumonology, Lungenklinik Hemer, Federal Republic of Germany.
authors.forename: R
authors.initials: R
authors.lastname: Achatzy
authors.forename: W
authors.initials: W
authors.lastname: Beba
authors.forename: R
authors.initials: R
authors.lastname: Ritschler
authors.forename: H
authors.initials: H
authors.lastname: Wörn
authors.forename: B
authors.initials: B
authors.lastname: Wahlers
authors.forename: H N
authors.initials: HN
authors.lastname: Macha
authors.forename: J A
authors.initials: JA
authors.lastname: Morgan
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D010994:Pleura / Q000601:surgery; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed