Mujoomdar Aneil A, Sugarbaker David J
Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Semin Thorac Cardiovasc Surg. 2008 Winter;20(4):298-304. doi: 10.1053/j.semtcvs.2008.11.002.
Malignant pleural mesothelioma is a uniformly fatal disease with a poor prognosis. Multimodality therapy, including macroscopic complete resection, chemotherapy and/or radiotherapy, has improved survival relative to historical controls, but local recurrence remains problematic. Novel strategies are needed to improve local control. Intracavitary chemotherapy (IC) can deliver higher doses of drug locally with less toxicity than corresponding systemic therapy. When combined with hyperthermia, there is also an increase in local drug absorption and cytotoxic effect. Several phase I and II clinical trials have shown IC to be safe and feasible. Our experience and technique of hyperthermic IC is described. The evolution of our experience has led to the use of pharmacologic renal cytoprotection, which has permitted the safe administration of higher doses of IC than previously described. Further trials are being performed with a multidrug combination following macroscopic complete resection.
恶性胸膜间皮瘤是一种预后极差、必死无疑的疾病。与历史对照相比，包括宏观完全切除、化疗和/或放疗在内的多模式治疗已提高了生存率，但局部复发仍然是个问题。需要新的策略来改善局部控制。腔内化疗（IC）能够在局部给予更高剂量的药物，且毒性低于相应的全身治疗。与热疗联合使用时，局部药物吸收和细胞毒性作用也会增强。多项I期和II期临床试验表明IC是安全可行的。本文描述了我们热疗IC的经验和技术。我们经验的发展促使我们使用药物性肾细胞保护，这使得我们能够安全地给予比之前报道更高剂量的IC。在宏观完全切除后，正在进行多药联合的进一步试验。
