How to diffuse mesothelioma treatment?

Until today for malignant pleural mesothelioma have not yet effective treatment, but after treatment in one way or another, have a small number of patients live at home and abroad over 5 years up to 22 years, most people think may be related to natural tumor survival and sub - The relevant period. Butchart according to the stages of malignant pleural mesothelioma is divided into four phases (Table 1).



According to the clinical phase Ⅰ E-malignant pleural mesothelioma may have long-term survival, it is suggested that these patients for radical resection of lung pleura. Ⅱ Ⅲ Ⅳ of the period and E-pathology and other types of cases, both dead and the government to adopt radical or palliative operation and the use of chemotherapy and radiation treatment efficacy or otherwise of the survival curve is basically the same, the average survival time for 18 months About 10% of patients survive beyond the 3-year



Table 1 of malignant pleural mesothelioma clinical stage

Phase Ⅰ tumors confined to the parietal pleura only involved the same side pleura, lung, pericardium and mediastinal

Phase Ⅱ tumor chest wall or structure that is involved mediastinal esophagus, heart and the opposite pleura. Only in the chest lymph node involvement (N2)

Phase Ⅲ tumor through the diaphragm involved pleural and peritoneal violation of the opposite sides in the chest, involving the lymph nodes in the chest outside

Ⅳ period of blood-borne distant bone metastases



1 palliative treatment of malignant pleural mesothelioma patients, needle aspiration will occur very soon after, with chemical agents into the pleural cavity caused by pleural adhesions, the majority of patients with pleural effusion under control, so if pleurodesis failure or to be Line diagnostic thoracotomy patients should consider doing pleural endarterectomy.



Malignant pleural mesothelioma can puncture holes along the channel's own chest and thoracic incision disseminated, but the skin caused by sediment rarely cause symptoms and therefore do not have to be given treatment if the treatment of patients, the skin as nodule can also observe the effect Indicators.



Malignant pleural mesothelioma patients with chest pain is the most difficult to deal with the symptoms late in the particularly serious and continuing non-stop all day, without radiation therapy response should be given adequate sedation analgesics, including opiates agents in order to alleviate pain, a peaceful transition to life in the last moment



2 At present, surgical treatment of a variety of surgical treatment of malignant pleural mesothelioma, is the first expansion of pleural pneumonectomy, that is radical resection of the involved were part of the chest wall the whole lung, diaphragm, mediastinal and pericardial this procedure applies only to Ⅰ E-period features of malignant pleural mesothelioma cases. Serious heart and lung damage is contraindication of this technique. 4 intercostal do a standard posterolateral thoracotomy incision will be tough and pleural thickening of the wall and the tumor nodules together, blunt chest wall from the spin-off, this can cause extensive bleeding oppression, electrocautery and suturing Carefully complete stop bleeding. And then mediastinal pleura from the top of the hilar separated from the trachea removal of lymph nodes. In front of the apex at the level of internal mammary artery ligation and vein, the former chest wall and the removal of these blood vessels and pleural together all the lymph nodes can be seen in the back, the removal protuberans trachea and esophagus next to the area lymph nodes. From behind the left side of the corresponding part of the pericardial incision at this time decided to cut lung resection or first diaphragm, which depends on the order of the tumor site and its extension. Cross-sectional and hilar vascular and bronchial treatment as any in the pericardial (of expansion) as pneumonectomy. Unlike the lower part of the pleura diaphragm low as can be free in the pleural pleural resection of the lower part of the diaphragm outside the fold. In order to fully exposed, there are generally the same side in the 8 to 10 for the 2nd intercostal incision as a result of surgery patients in the home side, the removal of the diaphragm, tend to the liver from mediastinal shift to the oppression of the inferior vena cava, and lead to heart Obstacles to the flow. Diaphragm defects after the removal of the available network Maxlex Dilun or silica material to repair, it was used to repair spinal. No matter which materials and technology must not be missed tight to prevent the effusion of blood or chest by the farmers would flow into the abdominal cavity; should be used for suture, the diaphragm will be a substitute for a strong suture remnants of the diaphragm so that the edge into the intra-abdominal organs or not Hernia into the chest cavity. Guan chest chest tube should be connected to the suction device to attract. To expand pleura of the lung resection surgery mortality rate of 10% to 25% but the effect is no less than pleural resection, and therefore does not recommend wider use.
The second measure surgeon for the treatment of pleural resection of this non-radical surgery, as a result of the tumor and its often tired following the lungs. This surgery does not improve patients with malignant pleural mesothelioma survival time but it seems able to control the pleural effusion, to improve the patient's quality of life. In addition malignant pleural mesothelioma caused by chest pain, and sometimes in remission after removal of the pleura, the membrane static suspected malignant mesothelioma cases intended for the diagnosis of thoracic biopsy should be considered at the same time do pleural resection. Pleural effusion and a large number of chemical pleurodesis failure of the case, it may consider doing pleural resection. From the surgery is described in the pleural palliative operation, with the aim of parietal pleura and the removal of some of the visceral pleura, pleural effusion to prevent recurrence of symptoms of chest pain and reduce the general rule for the 6th intercostal posterolateral thoracotomy incision, blunt or sharp Free-wall and part of the tumor was extended to the visceral pleura, respectively, from the chest wall and lungs removed after the separation of this cause as a result of heat caused by spinal cord or nerve plexus damage in the spinal peri-top chest to remove the tumor, it is best to use high Argon-frequency knife in particular to be careful to keep at the top of the chest and mediastinum area of nerves and blood vessels, as far as possible to remove the tumor, will help reduce the volume of postoperative radiotherapy and chemotherapy. Chi Bi surgery closed thoracic drainage suction.



3 anthracycline chemotherapy agents are considered effective for malignant pleural mesothelioma, followed by cisplatin, mitomycin cyclophosphamide, fluorouracil, methotrexate Vindesine, and so on, the current use, anthracycline Class-based chemotherapy integrated in recent years, statistics at home and abroad in order to adriamycin-based chemotherapy, with a total effective rate was about 20% of which is good new alkali Afghanistan (CAO); non-anthracycline treatment of a variety of The total effective rate of 21%, which is better mitomycin plus cisplatin (MP). Cisplatin increase the dose methotrexate chemotherapy continued until did not aggravate the condition so far.



4 external radiation therapy for malignant pleural mesothelioma radiotherapy very disappointed, but the expansion of external radiation therapy is considered effective, can alleviate some of the cases of chest pain and pleural effusion control of disease but the disease itself has no effect. There are more than 40Gy irradiation in vitro palliative effect, 50 ~ 55Gy irradiation remission rate of 67% of the small number of patients survive 5 years, but almost all patients still die of recurrence or metastasis.



Brachytherapy on a small number of malignant pleural mesothelioma have a reaction and a small number of patients with long-term effect, it appears that there is a ray of hope. The main use of radioactive isotope is covered with gold serous cavity of the cell have affinity, particularly suitable for the treatment of diffuse tumors, such as mesothelioma, the main effect of treatment as a result of the radioactive β plasmid, and its ability to penetrate up to 2 ~ 3mm, for the most effective cancer early, but very difficult to find early cases of malignant pleural mesothelioma. Application of colloidal gold 198 years ago into the pleural cavity, there is live over 5 years a small number of cases because of difficulties in protection, at present there are only a few applications.



Comprehensive treatment and surgery or radiation isotope 132I192Ir, 32P, as well as cavity after implantation of radiation plus chemotherapy in vitro, and other measures are no long-term cure



5 comprehensive treatment in recent years, integrated treatment measures in the pleural pneumonectomy letter and CAP chemotherapy (cyclophosphamide 600mg/m2 Adriamycin 60mg/m2,, cisplatin 75600mg/m2, continuous treatment with 5 per course of treatment Intervals for 3 weeks). After the original tumor site, or residual tumor location for the 55Gy irradiation in vitro. Analysis of 53 cases of patients to receive comprehensive treatment of perioperative complication rate of 17%, 5.8% operative mortality. The average survival time of 16 months (1 to 8 years) 31 cases of patients with E-1, 2, 3-year survival rate was 7% 50% and 2%; and mixed-sarcoma patients after two years of existence Rate of 45% and 7.5%, none survived 25 months there are local mediastinal lymph node metastases survive longer than those without lymph node metastases were short, E-lymph node-negative, the 5-year survival rate was 45% so early treatment is Important.