(A) treatment
The general effect of radiotherapy and chemotherapy are not satisfied with some reports in recent years, ADM has 50% of cases the treatment extended the survival period, but there are also reports that the invalid, it was also advocate the use of immune therapy, needs further observation, usually after diagnosis 1 ~ 2 years of death, so far, peritoneal mesothelioma is still a lack of standardized treatment, most scholars claim, including surgery, radiotherapy and chemotherapy after comprehensive treatment.
1. Surgical treatment on stage of disease is in stage Ⅰ, Ⅱ of cases, should the first choice, or for surgical treatment, including surgical resection, palliative resection of the tumor smaller, more limited lesions, should be complete resection of the tumor and organ involved; if more extensive disease should strive for resection of the primary tumor (palliative resection), a wide range of diseases, severe, has resulted in intestinal obstruction, surgical resection can not, palliative surgery can be considered to alleviate the patient's clinical symptoms, biological behavior of benign and low malignant peritoneal mesothelioma, surgery was very good effect, if any, can be re-resection recurrence, Zhu Weiqi and other reports 1 case of recurrence of malignant peritoneal mesothelioma for 20 years, has implemented many 5 second operation resection, reported in the literature, simply the best surgical treatment of a group of cases (7 cases), median survival was 147.2 months, therefore, some cases of peritoneal mesothelioma, surgery is still regarded as an effective treatment.
2. Radiotherapy including external beam radiotherapy and (or) irradiation, the choice of 60Co or 186 kV X-ray as the radiation source, for incomplete resection or unresectable cases, Ke Yi decided to whole abdominal irradiation lesions or local irradiation It is generally believed, peritoneal mesothelioma, pleural mesothelioma, radiation therapy as effective as well, which may be used with pleural mesothelioma radiation dose on the larger, Shanghai Medical University Cancer Hospital data indicate that whole abdominal irradiation, radiation dose per 6 7 weeks 2400cGy, patients with local recurrence rate can be reduced to 11.4%, 66.7% three-year survival rate, indicating that the effect of radiation on peritoneal mesothelioma is yes.
3. Chemotherapy to chemotherapy treatment of peritoneal mesothelioma are many reports now that the peritoneal mesothelioma, is moderately sensitive to chemotherapy, commonly used drugs: doxorubicin (ADM), cisplatin (DDP), vincristine ( VCR), cyclophosphamide (CTX), bleomycin (BLM) and stir-made anti-cancer drugs such as Hong prolactin, in which the efficacy of doxorubicin is most certainly, chemotherapy and systemic chemotherapy into the abdominal cavity chemotherapy.
(1) chemotherapy: systemic give anticancer drugs, drug distribution within the abdominal cavity less foreign data show that both single-agent or combination therapy, systemic chemotherapy was only 11% to 14%, combined chemotherapy, including: DDP ADM ; DDP CTX VCR; CTX VCR BLM, etc., but many scholars combined with chemotherapy did not improve the outcome.
(2) Intraperitoneal chemotherapy: in recent years that intraperitoneal injection of medication may improve the local drug concentration and reduce systemic side effects doxorubicin, intraperitoneal chemotherapy, not only can eliminate residual tumor tissue after surgery to reduce recurrence, but also to partial loss of tumor regression of the surgical patients, ascites reduced condition was under control, abdominal and intravenous dose of a similar amount, or slightly higher than the latter, repeated after 1 week, according to the condition of continuous injection of a few weeks, Ito, etc. to 1 case surgery resection of the patients failed to intraperitoneal injection of DDP, and the joint use of uracil and tegafur, 223 days after the patients had no abdominal mass, ascites completely disappeared, but in the first 8 months after pelvic tumor recurrence, re-awarded to DDP and hi tree base, the result is poor, Ma, etc. are continuous intraperitoneal perfusion with warm (continuous hyperthermic peritoneal perfusion, CHPP), local injection of DDP combined treatment of primary peritoneal mesothelioma, treatment no local adverse reactions, patients are can tolerate CHPP, followed up for 10 months, no treatment of 1 patient died because of CHPP.
Intraperitoneal injection of 33P peritoneal mesothelioma has a certain effect, has been reported with intravitreal injection of 33P, radiotherapy and cyclophosphamide treatment of malignant peritoneal mesothelioma, the patient survived for 17 years, is also useful intraperitoneal injection of radioactive colloid reports .
4. Biological response modifier biological response modifier (biological nesponse modifier, BRM) is the application of the body's own cells and molecules, answering internal and external environment to stimulate the body to participate in maintaining a stable internal environment, BRM through the mobilization of the body inherent ability to resist and eliminate the tumor, the treatment of cancer become the new model.
Cytokine interleukin (IL), interferon (IFN), tumor necrosis factor (TNF), etc. In addition to directly killing tumor cells, and can be activated in vivo anticancer effect of cancer cells or secreted factors, or the maintenance of immune effector cells proliferation, differentiation, can be used as adjuvant therapy for primary peritoneal mesothelioma.
Adoptive transfer of immune cells in the collection, separation, ascites carcinoma cells in the in vitro expansion, and has a killing activity induced lymphokine, activated killer cells (LAK), will be injected into the body, anti-tumor cells, while given IL-2, may improve the outcome.
(B) prognosis
Without treatment of malignant peritoneal mesothelioma, most living in just 1 year after diagnosis, many died of cachexia or small bowel obstruction, the thoroughness of cytoreductive surgery, intraperitoneal chemotherapy and other treatments to improve the prognosis of patients directly affected, there were reports of tumor reduction surgery and intraperitoneal chemotherapy for the treatment of multi methods to peritoneal mesothelioma, the average survival time of 50 to 60 months, women in relatively good prognosis, in addition to In addition, the biological behavior of the tumor itself has important prognostic significance, has been reported Analysis of a set of data shows that 4710 cases of epithelial type, mixed type and fiber type, the median survival was 11 months, 10 months and 5 months.
