Department of Clinical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK.
Lung Cancer. 2009 Nov;66(2):150-6. doi: 10.1016/j.lungcan.2009.06.014. Epub 2009 Jul 23.
Patients with malignant pleural mesothelioma (MPM), who undergo chest instrumentation, may develop seeding at the site of intervention, leading to subcutaneous tumour. This is believed to be reduced by the common practice of prophylactic irradiation to intervention tracts (PIT). However, evidence to support PIT is currently inadequate and contentious.
We carried out a systematic search of published literature for articles relating to the incidence of chest wall intervention tract metastases and the use of PIT in mesothelioma. In addition, a survey of current practice was conducted in 54 UK oncology centres.
Fourteen studies revealed an incidence of chest wall intervention tract metastases of 0-48% with a trend toward a higher rate of metastases for more invasive procedures. Three randomised controlled trials (RCTs), two prospective non-randomised studies and five retrospective series met the eligibility criteria to evaluate the role of PIT in MPM. Of the three RCTs, two did not support the use of PIT. None of the RCTs included patients who had received systemic chemotherapy. Of the oncology centres responding to the survey, 75% practiced PIT, and 80% would be interested in a trial to determine the efficacy of PIT.
No consensus has been reached to support the use of PIT. However, most centres in the UK still offer PIT. There was widespread interest in a randomised controlled trial to establish PIT efficacy in the era of effective systemic chemotherapy for malignant pleural mesothelioma.
接受胸部器械操作的恶性胸膜间皮瘤（MPM）患者可能会在介入部位发生播种，导致皮下肿瘤。据信，预防性照射介入部位（PIT）可减少这种情况。然而，目前支持 PIT 的证据不足且存在争议。
我们对发表的与胸壁介入部位转移和 PIT 在间皮瘤中的应用相关的文献进行了系统搜索。此外，还对英国 54 家肿瘤中心的当前实践进行了调查。
14 项研究显示，胸壁介入部位转移的发生率为 0-48%，侵袭性更强的手术转移率更高。三项随机对照试验（RCT）、两项前瞻性非随机研究和五项回顾性系列研究符合评估 PIT 在 MPM 中的作用的标准。这三项 RCT 中有两项不支持 PIT 的使用。没有一项 RCT 纳入接受过全身化疗的患者。对调查做出回应的肿瘤中心中，75%实施了 PIT，80%有兴趣参加一项试验以确定 PIT 的疗效。
没有达成共识支持 PIT 的使用。然而，英国的大多数中心仍然提供 PIT。在有效全身化疗治疗恶性胸膜间皮瘤的时代，广泛有兴趣进行随机对照试验以确定 PIT 的疗效。
