Survival of Mesothelioma in a Palliative Medical Care Unit in Egypt


Background: This study was to evaluate the survival of patients with pleural and intraperitoneal malignantmesothelioma and to investigate the efficacy of chemotherapy (CT) as well as radiotherapy (RTH) and surgerycompared to best supportive care (BSC). Materials and
Methods: Forty patients with malignant mesothelioma(38 with pleural and 2 with intraperitoneal) were enrolled. Twenty seven patients underwent (CT) chemotherapyof which 2 also received (RTH) and surgery was only for biopsy in 15/40. Combination chemotherapy includedcisplatin-gemcitabine, cisplatin-navelbine and cisplatin (or carboplatin) with premetrexed. Thirteen patientsreceived only best supportive care.
Results: A total of 12 (30%) patients were male, and 28 (70%) female. Medianage was 54.0 years and the male/female ratio was 1/2.33 (P=0.210). Residential exposure played a major role intwo regions, Helwan and Shoubra, in 20% and 15%, respectively. Overall mean survival time was 13.9±2.29months. That for patients who had received best supportive care was 7.57±1.85 months, for chemotherapy was16.5±3.20 months, and multimodality treatment regimen 27±21.0 months (P=0.028). Kaplan-Meier survival didnot significantly vary for sex, residence and the pathological types epithelial, mixed and sarcomatous. The mediansurvival for performance status and treatment modalities was significant (P=0.001 and 0.028). Best supportivecare using opioids with a mean dose of 147.1 mg (range 0-1680) of morphine sulphate produced good subjectiveresponse and reasonable quality of life but did not affect survival.
Conclusions: We conclude that CT prolongssurvival compared to BSC in patients with malignant mesothelioma. Moreover, using escalating doses of opioidsprovides good pain relief and subjective responses.