Diffuse mesothelioma treatment

Until today, the malignant pleural mesothelioma Shangfu effective treatment, but after some treatment, are a small number of patients live at home and abroad over five years, the longest of 22, most people think could be the natural survival of tumor And the stage. By Butchart stage, malignant pleural mesothelioma is divided into four (Table 1).

Until today, the malignant pleural mesothelioma Shangfu effective treatment, but after some treatment, are a small number of patients live at home and abroad over five years, the longest of 22, most people think could be the natural survival of tumor And the stage. By Butchart stage, malignant pleural mesothelioma is divided into four (Table 1).

According to clinical manifestations, Ⅰ epithelial type of malignant pleural mesothelioma may have long-term survival, the proposal for these patients radical pleural pneumonectomy. The Ⅱ, Ⅲ and Ⅳ E-pathological and other types of cases, regardless of governance and died, a radical or palliative surgery and the use of chemotherapy and radiation effects or not, after treatment the survival curve is basically the same, the average survival time for 18, approximately 10% of patients survive for three years.

Table 1 malignant pleural mesothelioma clinical stage

Ⅰ pleural tumors confined to the layer, only involved the same side pleura, lung, pericardium and mediastinal

Ⅱ tumors of the chest wall or involved mediastinal structure, that is, esophagus, heart and contralateral pleura. Lymph node involvement only in the chest (N2)

Ⅲ period through the diaphragm involved retroperitoneal tumor, and bilateral pleural violations of the contralateral breast, chest, involving the lymph nodes

Ⅳ period distant blood-borne bone metastases

1. Palliative treatment of malignant pleural mesothelioma patient's pleural effusion, puncture aspiration will be there soon after, using chemical injection pleural cavity, causing pleural adhesions, the majority of patients with pleural effusion under control, so if the pleural fixation failure or To be in line diagnostic thoracotomy patients should consider stripping of pleural done.

Malignant pleural mesothelioma can along the puncture hole, home Xiongguan access and dissemination thoracotomy incision, but the skin caused by sediment rarely cause symptoms, there is no need treatment if the treatment given to patients, they also can be used as subcutaneous nodules Clinical observation of the target.

Malignant pleural mesothelioma patient's chest pain is the most difficult to deal with the symptoms, especially in the late serious, sustained non-stop all day, did not respond to radiotherapy, should be given adequate sedation analgesics, including opiates to relieve pain preparation, crossing the last moment of life .

2. Surgical treatment there are all kinds of surgical treatment of malignant pleural mesothelioma, is the first expansion of the pleural pneumonectomy, which was involved with radical part of the chest wall, lung, diaphragm and pericardium and mediastinum. This procedure applies only to stage Ⅰ functional E-malignant pleural mesothelioma cases. Serious heart and lung damage was the taboo of this card. In the fourth intercostal do a standard posterolateral thoracotomy incision, tenacity and pleural thickening layer and the tumor together, blunt dissection from the chest wall, this action will cause extensive bleeding, oppression, and electrocautery Suture carefully completely stop bleeding. Then, mediastinal pleura from the top of hilar separate, adjacent lymph nodes removed trachea. In front of the Feijian, ligation mammary artery and vein, with the past, chest wall and pleura of these vessels and lymph nodes that all together. Behind, with esophagus and trachea eminence area next to the lymph nodes. Left behind from the corresponding part of pericardial incision. At this time to decide to cut lung resection or first diaphragm, this sequence depends on the tumor site and the extension of the scope. Transverse hilar and vascular and bronchial, as in any way deal with pericardial (widening), like lung resection. Pleural lower than low, as the diaphragm, may be free after the pleura, the lower part of the pleural fold, with the diaphragm. In order to fully exposed, generally the same side in the 8 to 10 intercostal for the first two incision. Because of in-home patients in the lateral, with the diaphragm, liver preferred by the shift to the mediastinum, the oppression of IVC, resulting in heart rate and blood flow obstacles. With the diaphragm, the defect can be used Maxlex siliceous material in polyester fibre network or repair, it was also used epidural repair. Whether the use of any material and technology must be closely not leak, to prevent blood from the chest or pleural effusion into the abdominal cavity of Agriculture Council; should be continuous suture, the diaphragm will be a substitute for the residual solid suture diaphragm edge, so that intra-abdominal organs can not be Or into the hernia into the chest. Commissioner of the front should be connected to attract Xiongguan with suction. Expansion of the pleura of the lung resection surgery mortality rate of 10% to 25%, but the effect is no less than pleural resection of good, it does not recommend wider use.

The second surgical treatment for pleural resection, in this non-radical, often tired because of cancer of the lung and below. This operation can not improve the malignant pleural mesothelioma patient's survival time, but it seems to control pleural effusion, improving the patient's quality of life. In addition, the malignant pleural mesothelioma caused by chest pain, sometimes with ease after the pleura, the membrane static suspected to be malignant mesothelioma cases, intended for the diagnosis of thoracic biopsy, consideration should be given at the same time do pleural resection. A large number of pleural effusion, and the chemical pleurodesis failure of the case, could also consider doing pleural resection. From the above, the pleural resection of the palliative operation, with the aim of pleural layer with some visceral pleura and to prevent the recurrence of pleural effusion and reduce chest pain symptoms. The general rule for the first six intercostal posterolateral thoracotomy incision, blunt or sharp free layer of the tumor and part of the visceral pleura involved, from the separation of the chest wall and lungs removed, this action will cause the spinal cord caused by heat conduction or arm Plexus damage, in the thoracic spine Pangji top tumor resection, it is best to use high-frequency argon knife. In particular must be careful to retain the top and mediastinal chest nerve and vascular areas, as far as possible, with tumors, reducing its volume and is conducive to postoperative radiotherapy and chemotherapy. Completed the purchase of closed thoracic drainage suction.

3. Anthracycline-chemical treatment of Pharmacy is considered to be effective malignant pleural mesothelioma, followed by cisplatin, mitomycin, cyclophosphamide, fluorouracil, methotrexate, Navelbine amide, the current use of , Anthracycline-based integrated chemotherapy. In recent years, the statistics at home and abroad to doxorubicin-based chemotherapy, overall response rate was 20 percent, of which Azerbaijan is a better new base (CAO); non-anthracycline type of treatment the overall efficiency 21% of which is better mitomycin plus cisplatin (MP). Cisplatin increase the dose methotrexate. Chemotherapy does not continue to increase until illness.

4. Radiotherapy for external radiation therapy for malignant pleural mesothelioma very disappointed, but the expansion of radiotherapy in vitro were considered effective, can mitigate some cases of chest pain and control of chest fluid, but the disease does not have the effect of the disease. 40 Gy in vitro exposure of more than a palliative effect, 50 ~ 55 Gy irradiation remission rate was 67%, a small number of patients survive five years, almost all patients still die of recurrence or metastasis.

Cavity radiotherapy on a small number of malignant pleural mesothelioma have some response, and a small number of patients long-term effect, it appears that a glimmer of hope. Mainly by the radioactive isotope is, cover it with serous cavity of the affinity of the cell, particularly suitable for the treatment of diffuse tumors, such as mesothelioma. Its main effect is due to the treatment of radioactive β plasmid, the penetrating power of 2 ~ 3 mm, the most effective in the early tumor, but difficult to find early cases of malignant pleural mesothelioma. Early application of colloidal 198 into the pleural cavity, live five years a small number of cases, because of difficulties in protection, is now rarely applied.

Comprehensive treatment and surgery or radiation isotope 132 I, 192Ir, 32P cavity and implanted after in vitro measures such as radiotherapy and chemotherapy, who had no long-term cure.

5. Comprehensive treatment in recent years, a comprehensive treatment measures, in the pleural pneumonectomy letter and CAP chemotherapy (cyclophosphamide 600 mg/m2, doxorubicin 60 mg/m2,, cisplatin 75600 mg/m2, with five consecutive treatment Each treatment interval for three weeks). After the original tumor site or the location of residual tumor in vitro for 55 Gy irradiation. Analysis of 53 cases of patients receiving comprehensive treatment, perioperative complication rate of 17%, 5.8% operative mortality. The average survival time of 16 months (1 to 8 years). E-31 cases of patients 1, 2, 3-year survival rates were 7%, 50% and 2% mixed and sarcoma-1, 2 years after the patient's survival rate was 45 per cent and 7.5 per cent, with no live Than 25 months. Local mediastinal lymph node metastasis survival time than those without metastasis short, E-lymph node-negative, their 5-year survival rate of 45%, early treatment is important.