Bille Andrea, Belcher Elizabeth, Raubenheimer Hilgard, Landau David, Cane Paul, Spicer James, Lang-Lazdunski Loïc
Department of Thoracic Surgery, Guy's Hospital, 6th Floor, Borough Wing, Great Maze Pond, London, SE1 9RT, UK.
Gen Thorac Cardiovasc Surg. 2012 May;60(5):289-96. doi: 10.1007/s11748-011-0915-9. Epub 2012 Mar 28.
The treatment of malignant pleural mesothelioma (MPM) remains controversial. We present a prospective study of patients treated at our institution with neoadjuvant chemotherapy, extrapleural pneumonectomy (EPP), and radical radiotherapy.
Patients with MPM who were eligible for EPP and multimodality therapy were included in this study. Staging was through computed tomography and positron emission tomography and computed tomography (PET/CT) scanning, video-assisted thoracoscopic surgery (VATS), and mediastinoscopy. Our protocol involved three cycles of cisplatin-based neoadjuvant chemotherapy followed by extrapleural pneumonectomy and adjuvant radiotherapy (54 Gy). All patients were followed up every 3-6 months until death.
From March 2004 through October 2008, 25 patients were referred for EPP following neoadjuvant chemotherapy. EPP was performed in all but three patients, who were found to have T4 disease at surgery. Surgical complications included arrhythmias (28%), bronchopleural fistulas (12 %), reoperations for bleeding (8%), acute respiratory distress syndrome (4%), pneumonia (4%), septicemia (4%), vocal cord palsy (4%), and Horner's syndrome (4%). The 30-day mortality was 4%. Adjuvant radiotherapy was administered to 81% of patients after EPP. Radiotherapy toxicities included thrombocytopenia, radiation pneumonitis, pulmonary embolus, radiation hepatitis, herpes zoster, transverse myelitis, and late constrictive pericarditis. Median survival from diagnosis was 12.8 months (95% confidence interval 7.8-17.7 months). One-year survival was 54.5%; 2-year survival was 18.2%. Disease progression occurred in 77.3% of patients. Nodal status (N0 disease versus N1-N2) or histology (epithelioid versus biphasic) had no significant impact on survival.
Despite recent advances in chemotherapy, surgery, and radiotherapy, survival rates remain low for patients with MPM completing multimodality therapy including EPP.
恶性胸膜间皮瘤（MPM）的治疗仍存在争议。我们开展了一项针对在我院接受新辅助化疗、胸膜外全肺切除术（EPP）和根治性放疗的患者的前瞻性研究。
本研究纳入了符合EPP及多模式治疗条件的MPM患者。分期通过计算机断层扫描和正电子发射断层扫描及计算机断层扫描（PET/CT）、电视辅助胸腔镜手术（VATS）和纵隔镜检查进行。我们的方案包括三个周期的以顺铂为基础的新辅助化疗，随后进行胸膜外全肺切除术和辅助放疗（54 Gy）。所有患者每3 - 6个月随访一次直至死亡。
从2004年3月至2008年10月，25例患者在新辅助化疗后接受EPP治疗。除3例患者外，其余患者均接受了EPP治疗，这3例患者在手术中被发现患有T4期疾病。手术并发症包括心律失常（28%）、支气管胸膜瘘（12%）、因出血再次手术（8%）、急性呼吸窘迫综合征（4%）、肺炎（4%）、败血症（4%）、声带麻痹（4%）和霍纳综合征（4%）。30天死亡率为4%。81%的患者在EPP后接受了辅助放疗。放疗毒性包括血小板减少、放射性肺炎、肺栓塞、放射性肝炎、带状疱疹、横贯性脊髓炎和晚期缩窄性心包炎。从诊断开始的中位生存期为12.8个月（95%置信区间7.8 - 17.7个月）。1年生存率为54.5%；2年生存率为18.2%。77.3%的患者出现疾病进展。淋巴结状态（N0期疾病与N1 - N2期）或组织学类型（上皮样与双相性）对生存率无显著影响。
尽管在化疗、手术和放疗方面取得了最新进展，但完成包括EPP在内的多模式治疗的MPM患者生存率仍然较低。
