Cancer Research Laboratories, Department of Surgery, St. George Hospital, Sydney, Australia.
Cancer Treat Rev. 2012 Oct;38(6):605-12. doi: 10.1016/j.ctrv.2011.10.006. Epub 2011 Nov 21.
Mesotheliomas are aggressive and lethal neoplasms arising from mesothelial cells lining the pleura, peritoneum, tunica vaginalis testis and pericardium. Malignant peritoneal mesothelioma accounts for about 30% of all mesotheliomas. Asbestos is the main known cause of the disease. Presenting symptoms in these patients include: ascites, abdominal pain, asthenia, weight loss, anorexia, abdominal mass, fever, diarrhea and vomiting. Electron microscopy, immunohistochemistry, computed tomography scan, echotomography, magnetic resonance imaging, positron emission tomography and laparoscopy are used in diagnosis and follow-up. Chemotherapy alone is considered as a palliative treatment for these patients who are not eligible for radical surgery. The most promising non-surgical approach today in the management of peritoneal mesothelioma is the use of the combination chemotherapy regime of an antifolate (pemetrexed and raltitrexed) and a platinum based (cisplatin) agent with a median survival of about 12-14 months. Due to peritoneal confinement of malignant mesothelioma and low occurrence of metastasis, a locoregional approach consisting of cytoreductive surgery and perioperative intraperitoneal chemotherapy has been introduced as a curative treatment option over the last decade with an overall 5-year survival rate of 29-63%. In this locoregional approach, surgery can separate the adhesions and remove the bulky tumor, leaving microscopic residual tumors much more susceptible to the killing effect of chemotherapeutic drugs. Here in St. George hospital, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (using cisplatin and doxorubicin) resulted in significant survival advantage. This article describes how the prognosis of the disease has changed over the last decade.
间皮瘤是一种来源于胸膜、腹膜、睾丸鞘膜和心包的间皮细胞的侵袭性和致命性肿瘤。恶性腹膜间皮瘤约占所有间皮瘤的 30%。石棉是该病的主要已知病因。这些患者的主要症状包括：腹水、腹痛、乏力、体重减轻、厌食、腹部肿块、发热、腹泻和呕吐。电子显微镜、免疫组织化学、计算机断层扫描、超声检查、磁共振成像、正电子发射断层扫描和腹腔镜检查用于诊断和随访。单独化疗被认为是这些不适合根治性手术的患者的姑息治疗。目前，在腹膜间皮瘤的治疗中，最有前途的非手术方法是使用抗叶酸剂（培美曲塞和雷替曲塞）和铂类（顺铂）联合化疗方案，中位生存期约为 12-14 个月。由于恶性间皮瘤的腹膜限制和转移发生率低，过去十年中引入了一种局部区域性治疗方法，即细胞减灭术和围手术期腹腔内化疗，总体 5 年生存率为 29%-63%。在这种局部区域性治疗方法中，手术可以分离粘连并切除大肿瘤，使残留的微小肿瘤更容易受到化疗药物的杀伤作用。在圣乔治医院，细胞减灭术和腹腔内热化疗（使用顺铂和多柔比星）带来了显著的生存优势。本文描述了过去十年间该病预后的变化情况。
