Law M R, Gregor A, Hodson M E, Bloom H J, Turner-Warwick M
Thorax. 1984 Apr;39(4):255-9. doi: 10.1136/thx.39.4.255.
We have carried out sequential prospective studies of treatment with surgery alone, chemotherapy, and radiotherapy in malignant mesothelioma of the pleura. The survival of treated patients was contrasted with that of 64 contemporary untreated patients whose clinical condition at presentation was comparable with that of the treated patients. Non-radical surgery alone (28 patients) was of palliative benefit, particularly for the control of recurrent pleural effusions, and may have prolonged survival in one patient with localised malignant mesothelioma. Chemotherapy with doxorubicin, vincristine, and cyclophosphamide (12 patients, with preceding surgery in eight) was without objective benefit. Megavoltage radiotherapy by an off axis beam rotational technique (12 patients, with preceding surgery in eight) abolished pain and dyspnoea and may have prolonged survival in one patient and terminated recurrent pleural effusions in three, but it was of no value in the other patients. There was no significant difference in survival between treatment groups or between treated and untreated patients, and no difference when mesotheliomas of epithelial, sarcomatous, and mixed cell types were examined separately. Treatment of this disease appeared to fail because of the unresponsiveness of the tumour to existing forms of treatment and the advanced stage of the disease at clinical presentation.
我们对胸膜恶性间皮瘤单纯手术、化疗及放疗进行了序贯前瞻性研究。将接受治疗患者的生存率与64例同时期未接受治疗患者的生存率进行对比，这些未治疗患者就诊时的临床状况与接受治疗患者相当。单纯非根治性手术（28例患者）具有姑息治疗作用，尤其对于控制复发性胸腔积液，并且可能使1例局限性恶性间皮瘤患者的生存期延长。采用阿霉素、长春新碱及环磷酰胺进行化疗（12例患者，其中8例先行手术）未取得客观疗效。采用非共面旋转技术进行兆伏级放疗（12例患者，其中8例先行手术）可消除疼痛和呼吸困难，可能使1例患者生存期延长，3例患者复发性胸腔积液终止，但对其他患者无效。治疗组之间、治疗患者与未治疗患者之间的生存率无显著差异，分别检查上皮型、肉瘤型及混合型间皮瘤时也无差异。本病的治疗似乎失败，原因是肿瘤对现有治疗方式无反应以及就诊时疾病已处于晚期。
