Treatment of Pleural Mesothelium

Abstract

To the Editor.— I was interested in the article by Strober et al, Malignant Pleural Disease: A Radiotherapeutic Approach to the Problem (226:296, 1973), that emphasized a simple, safe, and effective means of controlling malignant pleural disease. All of their patients had pleural disease as a result of metastases from another primary source, either lung or breast. May I comment briefly on another malignant pleural process that we treated recently with radiotherapy with equally satisfactory results. A 29-year-old man with an unexplained pleural effusion was ultimately found, by an open pleural biopsy (a previous needle biopsy was inconclusive), to have a diffuse malignant pleural mesothelioma. He had been subject to recurrent pleural effusions that had required multiple thoracenteses. There was no known exposure to asbestos. The therapy for this disease is not well established. Surgical excision has been replaced by intrapleural agents such as mechlorethamine hydrochloride and gold Au 198.