Malignant Pleural Mesothelioma in Singapore

Aim: To examine the clinical characteristics and outcomes of malignant pleural mesothelioma (MPM) in Singapore. Methods and Materials: A retrospective case note review of patients diagnosed with MPM between 1997 and 2007. Overall survival (OS), locoregional recurrence-free survival (LRS) and metastasis-free survival (MFS) were estimated using Kaplan Meier method and comparison were done using log rank test. Multivariate analysis was not done due to the small number of patients. Results: There were 39 patients diagnosed with MPM. Fifty-nine percent of patients presented with Stage III and IV disease. Eight (21%) patients had surgery with 2 patients receiving trimodality treatment and adjuvant chemotherapy respectively. Three patients received adjuvant RT and one patient had no adjuvant therapy. Twelve patients received palliative RT or chemotherapy. Median follow-up was 27.0 weeks. Median overall survival (OS) for all patients was 8.0 months (95% CI 6.3-9.7). One-year and 2-year OS were 25.6% and 6.4% respectively. Thirty-eight patients died of progressive disease and one patient died of other cause. Locoregional recurrences and distant metastases occurred in 3/8 and 5/8 surgically treated patients respectively. Overall, distant metastases occurred in 44% of patients. Surgery did not affect survival outcomes although patients with dual modality treatment showed a trend towards improved survival. Epithelioid tumours had better prognosis (median OS 10.2 months) compared to biphasic (median OS 8.0 months) and sarcomatoid tumours (median OS 1.4 months). Conclusion: Future management of MPM will need to emphasize on both locoregional and systemic control and hence, inclusion of patients in clinical trials for multimodality treatment should be encouraged.