van Sandick J W, Kappers I, Baas P, Haas R L, Klomp H M
Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Ann Surg Oncol. 2008 Jun;15(6):1757-64. doi: 10.1245/s10434-008-9899-9. Epub 2008 Apr 9.
A minority of patients with malignant pleural mesothelioma (MPM) are considered for surgery. To achieve a microscopically radical resection, combination with other treatment modalities is mandatory. The most effective combination is unknown. In our institute we have retrospectively analyzed the results of two combined modality regimens containing surgery.
Between January 2002 and September 2005, 15 MPM patients were treated with extrapleural pneumonectomy (EPP) and postoperative hemithoracic radiation (RT; 54 Gy). Previously, between January 1999 and December 2001, 20 patients underwent a combination of cytoreductive surgery - pleurectomy or EPP - and intraoperative hyperthermic intrathoracic chemotherapy (HITHOC), followed by radiotherapy to the thoracotomy scar and drainage tracts (24 Gy).
The median operating time for EPP/RT was shorter (5.3 versus 6.9 h; P < 0.0001). Postoperative complications occurred in 8 EPP/RT patients (53%) and in 14 HITHOC patients (70%). Two HITHOC patients died postoperatively. Median overall survival was 29 months for EPP/RT patients and 11 months for HITHOC patients (P = ns). The median time to local recurrence was not reached for EPP/RT patients, and was 9 months for HITHOC patients (P = 0.003). Local control was achieved in ten EPP/RT patients (67%) with a follow-up of 5-59 months compared to four HITHOC patients (20%) with a follow-up of 4-27 months.
In highly selected patients local control can be achieved with combination therapy but is accompanied by a high rate of (surgical) complications. Distant failure rates warrant further studies exploring the role of systemic chemotherapy while the use of cytoreductive surgery with intraoperative chemoperfusion for MPM is not supported.
少数恶性胸膜间皮瘤（MPM）患者适合手术治疗。为实现显微镜下的根治性切除，必须联合其他治疗方式。最有效的联合方案尚不清楚。在我们研究所，我们回顾性分析了两种包含手术的联合治疗方案的结果。
2002年1月至2005年9月期间，15例MPM患者接受了胸膜外全肺切除术（EPP）及术后半胸放疗（RT；54 Gy）。此前，1999年1月至2001年12月期间，20例患者接受了减瘤手术（胸膜切除术或EPP）联合术中胸腔内热化疗（HITHOC），随后对开胸切口及引流管部位进行放疗（24 Gy）。
EPP/RT组的中位手术时间较短（5.3小时对6.9小时；P < 0.0001）。8例EPP/RT患者（53%）及14例HITHOC患者（70%）出现术后并发症。2例HITHOC患者术后死亡。EPP/RT组患者的中位总生存期为29个月，HITHOC组患者为11个月（P值无统计学意义）。EPP/RT组患者未达到局部复发的中位时间，HITHOC组患者为9个月（P = 0.003）。EPP/RT组有10例患者（67%）实现局部控制，随访时间为5 - 59个月，而HITHOC组有4例患者（20%）实现局部控制，随访时间为4 - 27个月。
在经过严格挑选的患者中，联合治疗可实现局部控制，但伴随着较高的（手术）并发症发生率。远处失败率需要进一步研究以探索全身化疗的作用，而MPM采用减瘤手术联合术中化疗灌注的方法并不被支持。
