Malignant Pleural Mesothelioma , Mesothelioma Medicolegal Pitfalls

Further Outpatient Care
Regular follow-up visits with an internist, pulmonary specialist, medical oncologist, and radiation oncologist are recommended.

Complications
The tumor recurrence rate is 50% for those treated with surgery.

The mesothelioma mortality rate secondary to surgery has improved. Even with extensive surgery, the mortality rate as reported by Huncharek et al and by Sugerbaker et al in 1996 was 3.8%.30,12
Prognosis

Without treatment, mesothelioma is fatal within 4-8 months.
With trimodality treatment, some patients have survived 16-19 months. A few have survived as long as 5 years, with rates of 14% for all types and 46% for the epithelial type. However, numbers are small.

Miscellaneous
Medicolegal Pitfalls
This is a difficult diagnosis to establish, so warn the pathologist if the index of suspicion is high. The diagnosis could be work-related, and a thorough discussion with the mesothelioma patient is warranted.

The legal implications are tremendous, primary prevention is important, and employers should limit the amount of asbestos exposure to the lowest levels possible. Having work standards in place is important.
A good working relationship among the occupational mesotehlioma medicine specialist, the environmental hazard team, and the community at large is important.

Gene therapy: Phase I clinical trials have shown the safety of intratumoral gene transfer of recombinant adenovirus containing herpes simplex virus thymidine kinase, followed by ganciclovir treatment. Gene therapy trials are focusing on immunostimulation and using suicide gene therapy as a tumor vaccine. Studies are developing vaccines against simian virus 40, which is thought to be carcinogenic. Gene delivery of CD 40 ligand has shown promise in murine models of malignant mesothelioma