Choi Agnes Y, Singh Anand, Wang Danyi, Pittala Karthik, Hoang Chuong D
Thoracic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States.
Front Oncol. 2022 May 2;12:886430. doi: 10.3389/fonc.2022.886430. eCollection 2022.
Multimodality therapy including surgical resection is the current paradigm in treating malignant pleural mesothelioma (MPM), a thoracic surface cancer without cure. The main limitation of all surgical approaches is the lack of long-term durability because macroscopic complete resection (R1 resection) commonly predisposes to locoregional relapse. Over the years, there have been many studies that describe various intrapleural strategies that aim to extend the effect of surgical resection. The majority of these approaches are intraoperative adjuvants. Broadly, there are three therapeutic classes that employ diverse agents. The most common, widely used group of adjuvants are comprised of direct therapeutics such as intracavitary chemotherapy (± hyperthermia). By comparison, the least commonly employed intrathoracic adjuvant is the class comprised of drug-device combinations like photodynamic therapy (PDT). But the most rapidly evolving (new) class with much potential for improved efficacy are therapeutics delivered by specialized drug vehicles such as a fibrin gel containing cisplatin. This review provides an updated perspective on pleural-directed adjuncts in the management of MPM as well as highlighting the most promising near-term technology breakthroughs.
包括手术切除在内的多模式治疗是目前治疗恶性胸膜间皮瘤（MPM）的范式，MPM是一种无法治愈的胸壁表面癌症。所有手术方法的主要局限性在于缺乏长期疗效，因为宏观完全切除（R1切除）通常易导致局部区域复发。多年来，有许多研究描述了旨在扩大手术切除效果的各种胸膜内策略。这些方法大多是术中辅助手段。广义地说，有三类治疗方法使用不同的药物。最常见、使用最广泛的辅助药物组由直接治疗药物组成，如腔内化疗（±热疗）。相比之下，最不常用的胸腔内辅助手段是由光动力疗法（PDT）等药物-器械组合组成的类别。但最快速发展（新型）且具有很大疗效改善潜力的类别是由特殊药物载体递送的治疗方法，如含顺铂的纤维蛋白凝胶。本综述提供了关于MPM治疗中胸膜定向辅助手段的最新观点，并突出了最有前景的近期技术突破。
