Baldini E H, Recht A, Strauss G M, DeCamp M M, Swanson S J, Liptay M J, Mentzer S J, Sugarbaker D J
Joint Center for Radiation Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Ann Thorac Surg. 1997 Feb;63(2):334-8. doi: 10.1016/s0003-4975(96)01228-3.
Malignant pleural mesothelioma is uncommon, and presently, no standard treatment of this disease exists. The objective of our analysis was to study the patterns of failure for malignant pleural mesothelioma after trimodality treatment consisting of extrapleural pneumonectomy, chemotherapy, and radiation therapy.
Between 1987 and 1993, 49 patients with malignant pleural mesothelioma underwent extrapleural pneumonectomy. There were two perioperative deaths, and 1 patient died 5 weeks after extrapleural pneumonectomy. Thirty-five of the surviving patients received adjuvant chemotherapy (32/35 received cyclophosphamide, doxorubicin, and cisplatin) followed by hemithorax radiation therapy. Ten patients received chemotherapy but no radiation therapy, and 1 patient received no adjuvant therapy. Median follow-up time for the 23 living patients from the date of operation was 18 months.
Of the 46 evaluable patients, 25 had recurrence (54%), with a median time to first failure of 19 months (range, 5 to 51 months). The sites of first recurrence were local in 35% of patients, abdominal in 26%, the contralateral thorax in 17%, and other distant sites in 8%. (Some patients had recurrence in multiple sites simultaneously.)
The most common site of failure after trimodality therapy was the ipsilateral hemithorax. Isolated distant failures were uncommon. Future strategies should investigate methods of enhancing local tumor control.
恶性胸膜间皮瘤并不常见，目前尚无针对该疾病的标准治疗方法。我们分析的目的是研究经胸膜外全肺切除术、化疗和放疗组成的三联疗法治疗恶性胸膜间皮瘤后的失败模式。
1987年至1993年间，49例恶性胸膜间皮瘤患者接受了胸膜外全肺切除术。围手术期死亡2例，1例患者在胸膜外全肺切除术后5周死亡。35例存活患者接受了辅助化疗（32/35接受环磷酰胺、阿霉素和顺铂），随后进行半胸放疗。10例患者接受了化疗但未接受放疗，1例患者未接受辅助治疗。23例存活患者从手术日期起的中位随访时间为18个月。
在46例可评估患者中，25例复发（54%），首次失败的中位时间为19个月（范围5至51个月）。首次复发部位在局部的患者占35%，腹部占26%，对侧胸部占17%，其他远处部位占8%。（一些患者同时在多个部位复发。）
三联疗法后最常见的失败部位是同侧半胸。孤立的远处失败并不常见。未来的策略应研究增强局部肿瘤控制的方法。
