Pericardial Mesothelioma Treatment Options and Prognosis in 2025: What Patients and Families Need to Know

Primary pericardial mesothelioma (PPM) is an exceptionally rare and aggressive cancer that forms in the lining of the pericardium—the protective sac surrounding the heart. It accounts for less than 1% of all mesothelioma cases and has an estimated incidence of only 0.002% in large autopsy series. ² Because it is so uncommon, most physicians will never encounter a case in their careers, and diagnosis is frequently delayed or missed altogether.

The disease is notoriously difficult to detect early. Its symptoms—such as chest pain, fatigue, shortness of breath, and pericardial effusion—often mimic more common conditions like viral pericarditis or congestive heart failure. ^{1 2} As a result, pericardial mesothelioma is often diagnosed only after it has spread locally or caused life-threatening complications like cardiac tamponade.

Historically, most cases were discovered only after death, during autopsies. However, with improvements in imaging, immunohistochemistry, and clinical awareness, early diagnosis is now possible—especially when there is a known history of asbestos exposure. ^{4 1}

There is currently no universally accepted treatment standard for pericardial mesothelioma. Options are often adapted from pleural mesothelioma protocols, and treatment decisions are typically based on case reports, small series, and the clinical judgment of experienced oncologists and thoracic surgeons. ³

Prognosis by Histological Subtype

Like other forms of mesothelioma, the histological (cellular) subtype of a pericardial tumor is one of the most important predictors of prognosis. Although large-scale studies are lacking due to the rarity of pericardial mesothelioma, case reports and reviews provide meaningful insights.

Epithelioid Pericardial Mesothelioma

• This is the most common subtype, accounting for roughly 50–53% of pericardial cases. ⁵

• It is associated with the most favorable outcomes, particularly when diagnosed before myocardial invasion.

• Median survival in reported cases ranges from 9 to 13 months, though select patients treated with surgery and chemotherapy have lived over 3 years. ⁶

• A patient receiving bevacizumab plus cisplatin/pemetrexed achieved complete symptom relief and disease control for nearly a year. ¹

• Another case demonstrated 6-year survival following chemotherapy and immunotherapy with checkpoint inhibitors, even with metastatic spread. ⁵

Sarcomatoid Pericardial Mesothelioma

• This subtype accounts for about 24% of pericardial cases. ⁵

• It is the most aggressive variant and is often diagnosed late, with myocardial or pleural involvement.

• Median survival is poorly defined but estimated to be 4–6 months, with rapid progression and limited responsiveness to standard chemotherapy. ⁷

• Surgery is rarely an option due to extensive infiltration.

Biphasic (Mixed) Pericardial Mesothelioma

• Seen in approximately 23% of cases. ⁵

• Contains both epithelioid and sarcomatoid components, so prognosis varies based on which cell type dominates.

• Median survival tends to fall between epithelioid and sarcomatoid—often in the 6–10 month range in retrospective reviews.

Bottom Line

• Early diagnosis and subtype identification are critical. Patients with epithelioid histology may benefit from multimodal treatment, while those with sarcomatoid or biphasic tumors often require palliative care and symptom management.

• Histology can also guide treatment access—especially eligibility for surgery or immunotherapy trials.

Other Prognostic Factors

Stage at Diagnosis

Most patients are diagnosed late, often after pericardial effusion, tamponade, or heart failure symptoms. If caught before the tumor spreads beyond the pericardium, surgery may extend survival—but this is rare.
In most cases, the disease is classified as unresectable at diagnosis.

Performance Status

Patients with ECOG scores of 0–1 (more physically active) tolerate treatment better and may qualify for surgery or immunotherapy. Those with poor functional status often receive palliative care only.

Treatment Access

Patients treated at high-volume mesothelioma centers tend to do better, even with rare subtypes. Access to immunotherapy, radiation, and clinical trials—while uncommon for pericardial cases—may offer benefit, especially in early-stage or epithelioid disease.

Long-Term Survival with Pericardial Mesothelioma

Primary pericardial mesothelioma (PPM) is aggressive and often diagnosed late—but long-term survival is possible, especially in cases with epithelioid histology, early detection, and access to surgery or multimodal therapy.

In the past, survival beyond 12 months was considered exceptional. However, recent case reports show that with a combination of early diagnosis, modern chemotherapy, and targeted therapies like bevacizumab or immunotherapy, some patients are living significantly longer.

Notable Long-Term Survivors:

• A 59-year-old woman with epithelioid PPM underwent complete surgical resection and adjuvant chemotherapy (cisplatin + pemetrexed), and remained alive and recurrence-free for nearly 3 years—making her one of the longest postoperative survivors on record. ⁶

• A 57-year-old man diagnosed early due to high suspicion from asbestos exposure history received bevacizumab-based chemotherapy (bevacizumab + cisplatin + pemetrexed). He experienced complete symptom relief and disease control for nearly a year before discontinuing treatment. ¹

• A young woman with advanced epithelioid PPM treated with a long sequence of immunotherapy (pembrolizumab, atezolizumab) and chemotherapy survived over 6 years. Her disease remained stable for long stretches before eventually progressing. ⁵

What These Cases Suggest

• Histology matters: All long-term survivors had epithelioid tumors, which respond better to systemic therapies and are more likely to be resectable if caught early.

• Early diagnosis opens doors: In several cases, prompt imaging, pericardial biopsy, and immunohistochemistry led to faster treatment and better outcomes.

• Modern treatments help: Newer regimens—including bevacizumab, checkpoint inhibitors, and multimodal strategies—appear to play a role in improving survival, even in inoperable cases.

While most patients still face a challenging outlook, these stories show that pericardial mesothelioma is not always a short-term disease. Long-term control is possible, especially with individualized care and modern treatment strategies.

Hospitalization and Inpatient Care Costs

For patients with pericardial mesothelioma, the most expensive part of treatment is often not the medication or surgery—it’s the hospital stay itself. Whether you're admitted for a biopsy, pericardial drainage, tumor resection, or to manage complications like cardiac tamponade, inpatient care can quickly lead to five- or six-figure charges.

The tables below are based on a nationwide analysis of hospital discharge records from 1,675 mesothelioma patients, offering a detailed snapshot of how age and region impact both cost and length of care. ⁸

Hospitalization Costs by Region

Costs vary by geography, in part due to hospital type, local wages, and availability of advanced cardiothoracic services. The Northeast has the highest average costs, but this region is also home to some of the top academic hospitals specializing in mesothelioma, pericardial surgery, and advanced imaging. In pericardial cases, these differences can mean the ability to perform a rare but potentially life-extending resection versus settling for palliative drainage alone.

Cost and Length of Stay by Age

Patients aged 45–64 incur the highest average costs and longest hospital stays—likely because they're more eligible for aggressive treatments, including surgical tumor resection, systemic chemotherapy, and even investigational therapies. In contrast, patients over 85 are more often treated supportively, leading to lower hospital costs and shorter stays.

For pericardial mesothelioma specifically, younger patients with epithelioid tumors and early-stage disease may be eligible for pericardiectomy with bypass, often followed by chemotherapy. These interventions frequently require stays in cardiovascular intensive care units, which drives up cost—but also offers the best chance at extended survival.

Why Higher Hospital Bills May Reflect Better Care

Pericardial mesothelioma is rare enough that many community hospitals have never seen a case. In contrast, specialty cancer centers and academic cardiothoracic hospitals may offer:

• Cardiopulmonary bypass for surgical resection

• Access to newer treatments like bevacizumab or checkpoint inhibitors

• On-site pathology expertise for rare tumor subtypes

• Better outcomes—often months or even years of extended survival

While these centers often charge more, the difference isn’t just in the price—it’s in the results. One study found that mesothelioma patients treated at academic hospitals lived more than twice as long as those treated at community facilities (24.8 months vs. 11.6 months). ⁶

How We Help Patients Pay for Quality Care

Thanks to asbestos trust funds, VA benefits, and legal settlements, most patients with pericardial mesothelioma don’t have to choose between affordability and survival. We help families:

• Access top-tier cancer centers

• Cover travel, lodging, and hospital costs

• Pay for second opinions and out-of-network specialists

📞 Call 833-4-ASBESTOS to learn how legal compensation can help you get the best possible care—no matter where it’s offered.

Treatment Options for Pericardial Mesothelioma

There is no universally accepted standard of care for primary pericardial mesothelioma (PPM), largely due to the disease’s rarity. Most treatment approaches are adapted from pleural mesothelioma protocols or based on case reports and small case series. While overall prognosis remains poor, some patients have experienced meaningful symptom relief and survival benefits with aggressive or multimodal therapy. ^{4 2}

Surgical Treatments for Pericardial Mesothelioma

Surgical treatment for pericardial mesothelioma is typically palliative but may offer survival benefits in selected patients—especially those with localized disease and good performance status. Surgical approaches may include:

Pericardiectomy: Removal of part or all of the pericardium to relieve tamponade or chronic effusion.

• Average hospital charges: $45,000–$60,000
  Costs reflect the use of an operating room, inpatient monitoring, and possible ICU care if cardiac tamponade or effusion is present.

• Recovery time: 2–3 weeks
  Most patients are discharged within 3–7 days, with full recovery depending on overall health and comorbidities.

• Best candidates: Patients experiencing recurrent pericardial effusion or constrictive symptoms
  Often used for symptom relief rather than cure, especially when tumors are diffuse or unresectable.

Tumor mass resection: In cases where the tumor is well-circumscribed, resection can offer improved survival. One review of 103 published cases found that patients who underwent tumor resection (with or without pericardiectomy) had a median survival of 27 months—compared to 3 months for those who had no surgery. ⁴

• Average hospital charges: $60,000–$90,000
  Charges rise significantly if cardiopulmonary bypass, patch reconstruction, or multidisciplinary support is required.

• Recovery time: 3–6 weeks
  ICU stay of 1–3 days is common. Patients may require cardiac rehab depending on extent of resection and reconstruction.

• Best candidates: Early-stage patients with epithelioid histology, no myocardial invasion, and no lymph node involvement
  Requires high-resolution imaging and an experienced surgical team—most commonly performed at academic or specialized cancer centers.

Biopsy only: In cases where resection is not possible, surgery may still be needed to establish a diagnosis.

Surgical risks are significant, particularly when tumors are infiltrative or encase the heart. In one reported case, a patient underwent tumor resection from the right atrial wall, but complete excision was impossible, and the disease recurred within months. ³

Chemotherapy for Pericardial Mesothelioma

Systemic chemotherapy is the most commonly used and most studied treatment modality for PPM. The combination of a platinum agent (cisplatin or carboplatin) with pemetrexed is currently considered the first-line regimen, mirroring treatment for pleural mesothelioma. ^{4 2}

In one recent case report, a patient received six cycles of cisplatin and pemetrexed, along with bevacizumab—a targeted anti-VEGF antibody—and experienced full resolution of symptoms and measurable tumor response. While that patient eventually died one year after diagnosis, the response to therapy was considered unusually favorable for PPM. ¹

Bevacizumab has shown promise in pleural mesothelioma and may offer similar benefits in pericardial cases, particularly as part of a first-line regimen. However, evidence remains limited to individual reports. ^{1 2}

Multimodal Therapy is the Best Treatment Option for Pericardial Mesothelioma

Combining surgery with chemotherapy (and very rarely, radiation) appears to offer the best outcomes in patients well enough to tolerate both. In the largest published series, patients who received both mass resection and chemotherapy had significantly better survival than those who received only one modality. ⁴

• Median survival with chemotherapy alone: 13 months

• Median survival with no therapy: 0.5 months

• Median survival with bi- or trimodality therapy: 16 months.

• Median survival with surgery + chemotherapy: Up to 27 months in selected cases.

Radiation therapy is almost never used for PPM due to the risk of cardiac toxicity and the proximity of critical structures. No studies have shown a clear benefit from radiation in pericardial cases. ²

Reported Survival Outcomes in Primary Pericardial Mesothelioma (PPM)

Prognosis for Pericardial Mesothelioma

The overall prognosis for primary pericardial mesothelioma (PPM) is poor, even compared to other forms of mesothelioma. Median survival for most patients remains under 6 months, and the disease is often fatal within weeks if left untreated. ^{2 4}

A 2018 review of 103 published PPM cases found the following:

• Median overall survival across all patients: 6 months

• Median survival with no treatment: 0.5 months

• Median survival with chemotherapy: 13 months

• Median survival with surgery + chemotherapy: Up to 27 months in selected patients. ⁴

These numbers underscore the importance of prompt diagnosis and aggressive management when appropriate.

Key Prognostic Factors Influencing Survival

Survival outcomes vary significantly depending on several clinical factors:

• Use of chemotherapy
  The strongest predictor of improved survival. Patients who received chemotherapy (typically platinum + pemetrexed) lived more than 12 times longer than those who received no treatment. ⁴

• Tumor resectability
  Patients who underwent surgical mass resection had the best outcomes. Median survival was 27 months, compared to 1–3 months in unresectable cases. ⁴

• Extent of disease
  Localized disease with no distant metastasis at diagnosis was associated with significantly better survival. In the large case series, patients without mediastinal or distant spread had longer survival times than those with disseminated disease. ⁴

• Patient performance status
  Patients with good functional status (ECOG 0–1) were far more likely to tolerate treatment and live longer. Poor performance status was associated with shorter survival, even if treatment was attempted. ⁴

• Disease-free interval
  In patients who experienced recurrence after initial therapy, those with a longer disease-free interval (>12 months) had better post-recurrence survival. ⁴

While the numbers remain sobering, the growing body of case reports and small series suggests that outcomes are improving for some patients—particularly those who receive a timely diagnosis and multidisciplinary care. If diagnosed early, and if the disease is localized, some patients may live for a year or longer with modern chemotherapy or multimodal approaches.

Legal and Financial Support for Pericardial Mesothelioma

A diagnosis of pericardial mesothelioma can feel overwhelming—especially when it arises suddenly and with little warning. But even in this rare and aggressive form of mesothelioma, you may still be entitled to significant compensation if asbestos exposure played a role in your illness.

Asbestos Trust Funds

Many companies that manufactured or used asbestos-containing products have filed for bankruptcy and were required to create trust funds to compensate people harmed by their negligence. These trust funds continue to operate today and have paid out billions of dollars to victims and families.

Even if your exposure occurred 30 to 50 years ago—or through secondary exposure, such as laundering contaminated work clothes—you may still qualify for compensation. These funds can help cover treatment, caregiving, and travel expenses, as well as lost income.

Learn more about asbestos trust funds →

Lawsuits Against Active Companies

If the companies responsible for your asbestos exposure are still in business, we may be able to pursue a lawsuit directly against them. These cases frequently settle confidentially and often resolve without ever going to trial. Our team builds strong, well-documented claims to give your case the best possible outcome.

Learn more about mesothelioma lawsuits →

Government and Disability Benefits

Patients with pericardial mesothelioma may also qualify for:

• Social Security Disability (SSD) under the Compassionate Allowances program, which fast-tracks claims for serious illnesses like mesothelioma—sometimes delivering benefits within weeks.

• VA Benefits, if exposure occurred during military service. Veterans may be eligible for monthly compensation and specialized care at VA centers.

Get help with SSDI and VA benefits →

How We Help Families Facing Pericardial Mesothelioma

Our founding attorney has seen the devastation of asbestos-related cancer firsthand. After losing multiple family members to asbestos, he built a law firm dedicated to helping others through that same journey—with empathy, urgency, and fierce advocacy.

We take care of everything:

• Tracing where and how asbestos exposure occurred—even decades ago

• Gathering medical records and expert reports

• Filing claims with multiple trust funds and pursuing litigation when appropriate

• Helping with SSD, VA, and other benefit applications

• Collaborating with top mesothelioma doctors and researchers across the country

No Upfront Costs—Ever

We advance all expenses and only get paid if we recover money for you. With over $400 million recovered for clients, we have the experience and resources to handle even the most complex cases—including rare diagnoses like pericardial mesothelioma.

We Serve Clients Nationwide

Whether your exposure happened in a petrochemical plant, a shipyard, a military base, or at home, we can help—no matter where you live. With offices across the country and remote tools for virtual meetings, we make the process easy and accessible. If you'd rather meet in person, we’ll come to you at no charge.

A Way Forward

You’re focused on treatment and survival. Let us focus on securing your family’s financial future. We’ll help you understand your legal rights, identify any trust funds or companies that may owe you compensation, and move quickly to relieve financial stress so you can concentrate on healing.

📞 Call 833-4-ASBESTOS or contact us online for a free, confidential consultation.

There’s no obligation, no pressure—just help when you need it most.

References

• 1. Wang, D., Wang, Y. H., & Chu, S. C. (2023). Case report: Early diagnosis and bevacizumab-based chemotherapy for primary pericardial mesothelioma: A case with occupational asbestos exposure history. Frontiers in Cardiovascular Medicine, 10, 1257373. https://doi.org/10.3389/fcvm.2023.1257373

• 2. Cao, S., Jin, S., Cao, J., Shen, J., Zhang, H., Meng, Q., Pan, B., & Yu, Y. (2016). Malignant pericardial mesothelioma: A systematic review of current practice. Herz, 41(2), 163–170. https://doi.org/10.1007/s00059-016-4522-5

• 3. Apicella, G., Boulemden, A., Citarella, A., Sushma, R., & Szafranek, A. (2020). Surgical treatment of a primary malignant pericardial mesothelioma: Case report. Acta Chirurgica Belgica. https://doi.org/10.1080/00015458.2020.1736869

• 4. McGehee, E., Gerber, D. E., Reisch, J., & Dowell, J. E. (2018). Treatment and outcomes of primary pericardial mesothelioma: A contemporary review of 103 published cases. Clinical Lung Cancer, 20(3), e313–e321. https://doi.org/10.1016/j.cllc.2018.11.008

• 5. Arponen O, et al. Primary pericardial mesothelioma: a case report of a patient treated with an immune checkpoint inhibitor as the second-line treatment. Acta Oncol. 2021;60(5):687–691. doi:10.1080/0284186X.2021.1887515

• 6. Fujita K, et al. Three-year survival after surgery for primary malignant pericardial mesothelioma: report of a case. Surg Today. 2013;43(12):1366–1370. doi:10.1007/s00595-013-0511-y

• 7. Eren NT, Akar AR. Primary Pericardial Mesothelioma. Curr Treat Options Oncol. 2002;3(5):369–373. doi:10.1007/s11864-002-0002-7

• 8. Borrelli E, Babcock Z, Kogut S. Costs of medical care for mesothelioma. Rare Tumors. 2019;11:2036361319863498. doi:10.1177/2036361319863498