MPM is a disease with various types of presentation, frequently associated with thrombocytosis, sometimes with other tumors. Survival and diagnosis time can differ in various types of MPM. Prognosis is poor.

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Background. Pleural mesothelioma is a rare condition with a poor prognosis. The area of Monfalcone, North East Italy, provided a unique opportunity to study the disease because of its past heavy exposure to asbestos in local harbors and shipyards and its high necropsy rates. Methods. The effects of various patient and tumor characteristics on survival were evaluated in 80 patients (73 males and 7 females; median age, 69) of histologically or cytologically confirmed malignant mesothelioma of the pleura. These patients were examined between October 1979 and October 1991 at the General Hospital of Monfalcone in the Friuli‐Venezia Giulia region. Substantial exposures to asbestos were identified in 79 patients. Results. Median survival rate was 13 months (range, 2–44 months), and overall 2‐ and 5‐year survival rates were 23% and 0%, respectively. The factors that exerted a significant favorable influence on survival were as follows: (1) age younger than 65; (2) performance status less than or equal to one; (3) lack of less than or equal to 10% weight loss at any time; (4) Stages I and II; (5) epithelial or mixed histologic type; and (6) presence of pleural fluid with mesothelial cells but without neoplastic cells. When these factors were introduced in a Cox proportional hazard model, age, stage, and histologic type were the only independent prognostic factors. The increased hazards for patients, ages 65–74 (as compared to < 65), and for patients with sarcomatous histologic type (as compared to epithelial type) were 2.6 (95% confidence interval [CI], 1.2–5.7) and 4.5 (95% CI, 1.6–12.8). Conclusions. Survival rate in 24 untreated patients (median, 10 months) and 56 patients variously treated (median, 15 months) did not differ significantly. The availability of large portions of tumor specimens for histologic examinations in 77 of 80 patients, chiefly from high necropsy rate, strengthens the value of the present analysis of prognostic factors.

Background The clinical characteristics of malignant peritoneal mesothelioma are not fully known, and it appears as a variable entity with different types of clinical presentation and with a difficult diagnosis. Patients Fifteen patients with malignant peritoneal mesothelioma were analyzed for asbestos exposure, clinical presentation, thrombocytosis, X-rays and echotomographic findings, peritoneal fluid cytology, surgical investigations, diagnosis in vita, therapy, cause of death, diagnosis time, and survival time. Results Asbestos exposure was present in 12 men. Abdominal pain, ascites, abdominal mass, weight loss and fever were the most common presentation symptoms. In 5 patients, the disease presented as a surgical emergency. Assembling the presenting symptoms, malignant peritoneal mesothelioma was subdivided in 3 types: classical (6 cases), surgical (5 cases) and medical (4 cases). Thrombocytosis was present in 11 cases. Peritoneal fluid cytology was positive for neoplastic mesothelial cells in 8 of 10 cases. Laparotomy (5 patients) and laparoscopy (7 cases) were diagnostic in all cases. Diagnosis in vita was malignant peritoneal mesothelioma for 13 patients, peritoneal carcinomatosis for 1, with only 1 autopsy diagnosis. Seven patients were treated with chemotherapy, showing a progression of the disease. Mean symptoms-to-diagnosis time was 122 days (4-410), and mean symptoms-to-survival time was 345 days (45-1510). Conclusions Malignant peritoneal mesothelioma is a very unusual disease characterized by a difficult diagnosis, a rapid evolution, a poor response to therapy, and a very high prevalence of thrombocytosis. A new clinical classification into three types (classical, surgical and medical) may be useful for a correct diagnosis. The early diagnosis of malignant peritoneal mesothelioma remains an important open question.

BACKGROUNDMalignant pleural mesothelioma (MPM) is increasing rapidly worldwide. Currently, pemetrexed plus cisplatin chemotherapy showed a survival advantage versus cisplatin alone. No impact on patient survival of surgery, radiotherapy, or their combination has been demonstrated.METHODSEight centers in northeastern Italy participated in a Phase II multicenter study. Chemotherapy was comprised of carboplatin area under the concentration‐time curve 5 on Day 1 and gemcitabine 1000 mg/m2 on Days 1, 8, and 15. This cycle was repeated every 4 weeks.RESULTSBetween July 1996 and September 2000, 50 patients were treated. Of the sample, 68% were males, 88% had a Eastern Cooperative Oncology Group performance status score of 0–1, 56% had Stage I–II disease, 68% had epithelioid histology, and 62% had no previous treatments. The delivered dose intensity of gemcitabine was 617 mg/m2 per week, which was 82% of the planned dose (750 mg/m2 per week). For carboplatin, the delivered dose intensity was 80 mg/m2 per week. Overall, 44% of 15th day doses were omitted or reduced. Twenty‐six percent of the patients had partial responses (95% confidence interval: 15–40%) and 24% had disease progression. None of the patients had complete responses. The median response duration was 55 weeks (range, 13–113 weeks). Patients had good clinical benefit. For example, 46% had improved dyspnea, 40% improved in weight, and 26% experienced pain reduction. Patients developed Grade 3–4 leukopenia during 18 cycles (11%) of chemotherapy. Grade 3–4 thrombocytopenia occurred more frequently, i.e., there were 24 episodes (15%) among 17 patients. Grade 3 anemia developed among patients during eight cycles (5%). None of the patients developed Grade 3–4 nonhematologic toxicity. The median survival of this sample of patients was 66 weeks with 53%, 30%, and 20% of patients alive at 1, 2, and 3 years, respectively. The median progression‐free survival period was 40 weeks.CONCLUSIONSThe gemcitabine/carboplatin combination is a valid option in the treatment of MPM due to its acceptable toxicity profile, the good response rate, and the clinical benefit to patients. Minor adjustments in schedule (3‐week cycles instead of 4‐week cycles) would permit a more optimal treatment administration. Cancer 2003;97:2791–7. © 2003 American Cancer Society.DOI 10.1002/cncr.11405