恶性胸膜间皮瘤化疗进展

Progress on the medical treatment of malignant pleural mesothelioma

目的总结国内外对恶性间皮瘤(malignant pleural mesothelioma,MPM)内科治疗研究的现状。方法检索PubMed及CNKI期刊全文数据库检索系统,以"胸膜间皮瘤、内科治疗和化疗"等为关键词,检索2008-01-2013-10的相关文献,共检索到英文文献36条,中文文献22条。纳入标准:1)MPM的一线化疗;2)MPM的二线化疗;3)MPM的新辅助化疗;4)MPM的腔内化疗。根据纳入标准符合分析的文献37篇。结果培美曲塞+顺铂为标准一线化疗方案,以下药物也可用于MPM的一线化疗:1)培美曲塞+卡铂;2)吉西他滨+顺铂;可用于培美曲塞禁忌患者;3)单药一线化疗药物包括培美曲塞与长春瑞滨。当前尚没有确切MPM的标准二线化疗方案,对于曾通过接受一线含培美曲塞能延长无进展生存期的患者,再次接受含培美曲塞方案化疗或许不失为一种好的选择。术前新辅助化疗可提高术后局部控制率,降低复发及远处转移率。备选方案有吉西他滨联合铂类和铂类联合抗叶酸药物。术中腔内化疗(腔内热灌注顺铂等)已在临床中运用,可提高局部控制率。结论化疗是治疗MPM的主要手段,虽然恶性胸膜间皮瘤的诊断与治疗处于发展状态,但患者的预后仍较差。目前缺少Ⅱ、Ⅲ期的随机对照研究,需要前瞻性研究进一步评估不同化疗方案的毒副作用及对生存的影响。

OBJECTIVE To sum up the status of malignant pleural mesothelioma in medical treatment abroad. METHORDS Relevant articles were searched with ＂pleural mesothelioma,medical treatment,chemotherapy＂ as keywords in PubMed and CNKI database from January 2008 to October 2013. Totally 37 papers were selected and analyzed accord- ing to the inclusion criteria as follows： the first-line chemotherapy of MPM; the second-line chemotherapy of MPM; the neoadjuvant chemotherapy of MPM; the intracavitary chemotherapy of MPM. RESULTS The current standard first-line chemotherapy： pemetrexed plus carhoplatin; gemcitabine plus cisplatin can be used in the patients who contraindicated with peme- trexed; monotherapy of first-line chemotherapy includes gemcitabine and vinorelbine. So far, there were no standard second-line chemotherapy for threating MPM, but, if the patients who recieved the first-line including pemetrexed and prolonged the progres- sion-free survival,given another pemetrexed-containing chemotherapy may be a good choice. Neoadjuvant chemotherapy can im- prove the local control rates after surgery, reduce relapse and the distant metastasis rates. In clinical intracavitary chemotherapy has been used, which may improve the local control rates. CONCLUSIONS Chemotherapy is the primary means of treatment of MPM. Although the diagnosis and treatment of malignant pleural mesothelioma is improving, the prognosis is still poor. Current- ly, becouse lack of the randomized controlled trials in phase Ⅱ/Ⅲ ,it requires prospective studies to further evaluate the toxicity of different chemotherapy and the effective on survival.