In 1994, a 58 year old man complained of chest pain and shortness of breath. He had been exposed to asbestos previously through his work and was eventually diagnosed with malignant pleural mesothelioma. The patient decided not to have any active treatment at that time and continued with his life. Five years later he had an enlarging painless mass on his chest wall. A needle biopsy confirmed it was malignant. The patient had a left thoracotomy, multiple pleural biopsies, and chest wall resection. Pathology reconfirmed that the mass was malignant pleural mesothelioma. Seven years after the chest wall resection and 12 years after the initial diagnosis, the patient has no symptoms and no evidence of recurrence. No chemotherapy or radiation had been given.
The doctors who wrote up this case history for publication noted that there was “moderate host inflammatory response” and that “spontaneous regression may be an immune-mediated phenomenon.” In other words, the doctors hypothesized that the patient’s own immune system may have played a factor in his survival.
See: Pilling, J.E., et al., Prolonged Survival Due to Spontaneous Regression and Surgical Excision of Malignant Mesothelioma, Ann Thorac Surg, 2007; 83: 314-5.
14 Years
In 1986, a 65 year-old women had pain in her left chest wall. A chest X-ray revealed a small pleural effusion on this side. The patient declined an open biopsy and no diagnosis could be reached. She was treated for tuberculosis because of the high rate of this disease in her area. Her symptoms partially improved. In 1988 she had increasing pain over her chest. A biopsy was performed and malignant infiltration of the pleura was confirmed. She turned down treatment. In 1998, 10 years after the diagnosis of malignant pleural mesothelioma she had an enlarging mass over her left chest wall. Biopsy confirmed the diagnosis of pleural mesothelioma. She had a course of radiation and died in January 2000, 14 years after her initial symptoms.
The doctors who wrote this report counseled their colleagues that long-term survivors can occur with pleural mesothelioma and “one should not hold the belief that it is always the intervention that prolongs survival.” In other words, these doctors suggested that in some cases the intervention (i.e. chemo, radiation, surgery) may not be the factor that prolongs survival in pleural mesothelioma, but other factors may be at work.
See: Wong, C.F., et al., A Case of Malignant Pleural Mesothelioma with Unexpectantly Long Survival without Active Treatment, Respiration March/April 2002; 69, 2: 166-168.
7 Years +
In 1970, a 53 year-old man had shortness of breath and a sharp pain on his right side. An X-ray revealed a right side pleural effusion. The patient had worked at a plant adjacent to the Brooklyn Navy Yard from1955-1966 where asbestos had been used. In 1972 a thoracotomy was performed and a pleural biopsy was taken. The patient was diagnosed with malignant pleural mesothelioma. The patient never received any specific treatment for pleural mesothelioma. The report was written up in 1977 and apparently information about the continued life of this patient was not published after. We do not know how many more years or decades he lived.
The doctors noted in their discussion that, “This unusual course may be explained either by the presence of low-grade malignancy or by the unusual host resistance…Our findings are consistent with the concept that normal immunological function may effectively impede dissemination of the disease (malignant pleural mesothelioma).” In other words, these doctors are again alluding to how the immune system may play a role in managing pleural mesothelioma.
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