Deraco Marcello, Casali Paolo, Inglese M G, Baratti Dario, Pennacchioli Elisabetta, Bertulli Rossella, Kusamura Shigeki
Department of Surgery, National Cancer Institute of Milan, Milan, Italy.
J Surg Oncol. 2003 Jul;83(3):147-53. doi: 10.1002/jso.10255.
Peritoneal mesothelioma (PM) is a rare disease, with a poor prognosis. We decided to prospectively evaluate the prognostic impact of aggressive surgery followed by intraperitoneal chemotherapy with local hyperthermia.
In this prospective study, 19 patients with PM were treated by cytoreductive surgery (CRS) and intraperitoneal hyperthermic perfusion (IPHP). Mean follow-up was 27 months (range: 1-65). Fifteen (68%) patients had malignant disease, two had well-differentiated papillary mesothelioma, and two had multicystic PM. Thirteen (65%) patients received preoperative chemotherapy. Fifteen cases (75%) underwent optimal cytoreduction (residual disease <2.5 mm). One patient underwent the procedure twice due to locoregional progression. IPHP was performed with closed abdomen technique, using a preheated polysaline perfusate (42.5 degrees C) containing cisplatin + mitomycin C or cisplatin + doxorubicin administered through a heart-lung pump for 60 or 90 min.
Three-year overall and progression-free survival was 69 and 66%, respectively. The operative morbidity (grade II/III), mortality, and overall toxicity (grade I-IV) rates were 25, 0, and 30%, respectively. Seventeen (94%) out of 18 patients had resolution of ascites.
This therapeutic strategy proved feasible and was well tolerated. Early results seem promising and consistent with a potentially major impact on survival in selected patients with PM.
腹膜间皮瘤（PM）是一种罕见疾病，预后较差。我们决定前瞻性评估积极手术联合腹腔内热化疗的预后影响。
在这项前瞻性研究中，19例PM患者接受了细胞减灭术（CRS）和腹腔内热灌注（IPHP）治疗。平均随访时间为27个月（范围：1 - 65个月）。15例（68%）患者患有恶性疾病，2例患有高分化乳头状间皮瘤，2例患有多囊性PM。13例（65%）患者接受了术前化疗。15例（75%）患者实现了最佳细胞减灭（残留病灶<2.5 mm）。1例患者因局部进展接受了两次手术。IPHP采用封闭腹腔技术进行，使用预热的含顺铂+丝裂霉素C或顺铂+阿霉素的聚盐灌注液（42.5摄氏度），通过心肺泵输注60或90分钟。
三年总生存率和无进展生存率分别为69%和66%。手术 morbidity（II/III级）、死亡率和总体毒性（I - IV级）发生率分别为25%、0%和30%。18例患者中有17例（94%）腹水消退。
这种治疗策略被证明是可行的，且耐受性良好。早期结果似乎很有前景，与对部分PM患者的生存可能产生重大影响相一致。
