Palliative radiotherapy for malignant mesothelioma

169 627 PLEURECTOMY FOR MESOTHELIOMA McCaughan.B.C., Brancatisano.R.P., Joseph.M.G. Cardiothoracic Surgical Unit, Concord and Royal Prince Alfred Hospitals, Sydney, Australia. Fifty consecutive patients (pts) undergoing thoracotomy for pleural mesothelioma were reviewed to assess the effectiveness and safety of parietal pleurectomy in establishing a tissue diagnosis and controlling pleural fluid accumulation. In only 22% of pts was a tissue diagnosis made before surgery. At thoracotomy, subtotal parietal pleurectomy was performed in 45 of the 50 pts. In two pts, biopsy alone was performed and three pts were treated by a chemical pleurodesis only, as pleurectomy was not technically possible. Pulmonary decortication was required in 28 pts to allow full expansion of the underlying lung for effective pleurodesis. There was one post-operative death. The median survival was 16 months, ranging from 3 to 54 months, with 21% of pts surviving more than two Only one pt developed a reaccumulation years. of pleural fluid. We advocate early thoracotomy and pleurectomy, with decortication when required, in pts with suspected pleural mesothelioma.

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D. Prakmh, Hairmyres

A. N. Al-Jilaihwi,J. Glamer. Hospital,

East Kilbride,Glasgow,Scotland

PALLIATIVE RADIOTHERAPY FOR MALIGNANT MESOTHELIOMA. D Bissett, FR Macbeth & L Cram (Beatson Oncology Centre, Western Infirmary, GLASGOW Gil 6NT, UK). 22 patients with confirmed or clinically suspected malignant mesothelioma and significant chest pain were treated with palliative RT (30 Gy/lO fractions/2 weeks) to one hemithorax. Pain was assessed by the patients using a descriptive score and a linear analogue scale 2 monthly for 6 months before RT, at 4 weeks, and then 3 monthly. Changes in analgesic dosperformance status and age, in other symptoms, in clinically measurable disease were noted. All patients had extensive intrathoracic disease not suitable for surgery. 13 of 19 assessable patients showed an improvement in both pain scores at 4 weeks, with no increase in analgesia doses, but response duration was short (median 2 months), with pain as bad or worse than before RT by 3 months in 9 of 12 assessed. Objective response in measurable chest wall masses was seen in 5 of 9 patients but was also short-lived. The main toxicity was was nausea during RT, and no late morbidity seen. Increasing dyspnoea after RTwas probably due to progressive tumour rather than fibrosis. All patients were dead by 13 months (median 4). RT to the hemithorax at this dose is not toxic but its palliative effect, though real, is only short-lived.