Pleurectomy/decortication and adjuvant therapy for malignant mesothelioma.
Pleurectomy/decortication and adjuvant therapy for malignant mesothelioma.
复制标题
恶性间皮瘤的胸膜切除术/剥皮质术和辅助治疗。
作者：
V. Rusch
恶性间皮瘤是一种罕见的，通常是致命的癌症，没有标准的治疗方法。然而，由于无法通过放射有效治疗整个半胸并且缺乏有效的化疗药物，手术切除仍然是治疗的主要方式。胸膜外全肺切除术是唯一技术上可行的手术，对于那些有巨大的局部肿瘤和慢性肺卡压的患者，但胸膜切除术/去皮质术与较低的手术发病率和死亡率相关，并且似乎导致早期疾病患者同样良好的生存率。由于通过胸膜外全肺切除术或胸膜切除术/剥脱术进行手术切除后局部复发的风险很高，因此一直致力于开发有效的辅助治疗。胸膜切除术/剥脱术后给予放射治疗导致生存率的微小改善和显著的副作用。辅助化疗被认为是研究性的，但目前正在进行一项临床试验，在胸膜切除术/剥脱术后使用高剂量胸膜内和全身化疗进行评价。需要更多精心设计的前瞻性试验来改变这种疾病的悲惨结局。
Malignant mesothelioma is an uncommon and usually fatal cancer, for which there is no standard treatment. However, surgical resection remains the mainstay of treatment because of the inability to treat the entire hemithorax effectively with radiation and the lack of effective chemotherapy drugs. Extrapleural pneumonectomy is the only technically feasible operation for patients who have bulky local tumor and chronic entrapment of the lung, but pleurectomy/decortication is associated with a lower operative morbidity and mortality, and seems to lead to an equally good survival in patients who have early-stage disease. Because of the high risk of local recurrence after surgical resection by either extrapleural pneumonectomy or pleurectomy/decortication, efforts have been directed at developing effective adjuvant treatment. Radiation given postoperatively after pleurectomy/decortication has led to a minimal improvement in survival and to significant side effects. Adjuvant chemotherapy is considered investigational but is currently being evaluated in a clinical trial using high-dose intrapleural and systemic chemotherapy after pleurectomy/decortication. Additional well-designed prospective trials are needed to alter the dismal outcome of this disease.