There is a malignant tumor, the global annual incidence of 15,000 cases in the following, the incidence mainly concerned with exposure to asbestos,
Incubation period is usually 20 to 40 years, the majority of patients to the disease was discovered late, while median survival time of patients
Only 4 of 9 months, oncologists are very difficult to face it all - it is malignant pleural mesothelioma.
Recently, Eli Lilly and Company in Chengdu, "organized by the National Forum on pleural mesothelioma", the country nearly one hundred cancer professionals
Home for the first time to diagnosis and treatment of malignant pleural mesothelioma, treatment options and difficult problems and the latest academic research carried out. By
General Assembly and the relevant experts on interview, the reporter learned that the treatment of malignant pleural mesothelioma is difficult is that surgery
And little effect of conventional chemotherapy on the disease, and a target mechanism of action with three new chemotherapy drugs pemetrexed
Cypriot disodium (Pemefrexed disodium, Alimta), for the treatment of the disease brings hope.
Stripping cocoon spinning - diagnosis and treatment of many difficult
Malignant pleural mesothelioma is very familiar to many people: it is what kind of diseases? What is the original
Because it led to the occurrence? Can I prevent it from occurring? How to ... ... for the treatment of these problems,
At this forum, the Shanghai Chest Hospital, Professor Liao Meilin from the cause to the diagnosis and treatment of malignant pleural mesothelioma
Tumors are discussed and analyzed.
■ exposure to asbestos is the major cause of
"Malignant pleural mesothelioma from pleural mesothelial cells, the progress is a rare malignant tumor of the chest
Tumor. "Professor Liao Meilin points clear in the nature of malignant pleural mesothelioma, then the incidence of this disease and the causes for
Introduced.
Malignant pleural mesothelioma, accounting for 5% of pleural neoplasms, accounting for 0.02% of all cancer 0.4%, the foreign hair
Disease rate was 0.07% ~ 0.11%, 0.04% incidence of domestic.
Disease in the United States now new cases each year from 2000 to 3000 cases; Western Europe the incidence is about 5000 cases per year;
Australia since 1981, incidence increased year by year, the male population of 59.8 million people the disease, women
There are 10.9 million people, of human cases reported around the world countries with the highest incidence of the disease.
Malignant pleural mesothelioma is asbestos exposure the major pathogenic factors. Studies have shown that blue asbestos can cause cancer
By 10 times, amosite, and carcinogenicity of amosite chrysotile capacity of 10 times. But it is not only a direct connection with asbestos
Contact will be risk of malignant pleural mesothelioma, a report shows, by touching the clothes of staff indirect contact
Asbestos who also malignant pleural mesothelioma. In addition, 20% of the incidence of the disease may be associated with exposure to patients
Zeolite, glass fibers, radiation, SV40 virus, thorium dioxide, and family history (autosomal dominant inheritance
) Related.
Health hazards of asbestos in industrialized countries has received increasing attention. Start the United States since 1971
Prohibiting the use of asbestos in the workplace, so far the U.S. has passed the peak of the disease occurred. Related ban in Europe
Ling Wan in the United States, the estimated peak incidence of the disease in Europe in 2020. National awareness of the dangers of asbestos exposure
Slightly later, the peak incidence is estimated the disease has not yet come.
■ Most patients are diagnosed at late stage have to
Professor Liao Meilin pointed out that almost all patients were diagnosed with pleural mesothelioma, it already has a
Some of the symptoms of cancer, usually presents severe pain, breathing difficulties, weight loss and fatigue, 95% of patients will be out
Is pleural effusion. It is important to malignant pleural mesothelioma is the most severe symptoms of pain, this is because many
Nerve endings in the pleura, the tumor growth stimulation of nerve endings, so that patients achieve the incredible pain
Level. In addition, the lung tumor compression or compression, limiting diaphragm mobility, so that patients can not breathe properly.
Other symptoms of the disease include cough, hoarseness, fever, night sweats, breath sounds decreased or disappeared, showed unilateral pleural
"Frozen breast" shape, chest movement is limited.
■ the lack of specific diagnostic criteria
"The clinical manifestations of malignant pleural mesothelioma, no typical characteristics, and tuberculous pleurisy, pleural metastasis of lung cancer
With pleural effusion in the clinical manifestations, imaging features and the nature of pleural effusion have more in common, so the capacity
Easy to pleural mesothelioma misdiagnosed as tuberculous pleurisy, pleural metastasis of lung cancer. In this regard special attention should be! "Liaomei
Professor Lin stressed.
Diagnosis of malignant pleural mesothelioma are imaging, pleural effusion smears, cytology, and pleural
Such as biopsy and thoracoscopy. A typical chest X-ray showed diffuse irregular pleural thickening of the medial and the sudden to the chest
Membrane cavity multiple nodules, wavy (If this does not exist in the lung nodules but only widespread in the pleura,
Should be vigilant.) Visible lesions of human specimens often occurred in the parietal pleura or diaphragmatic pleura, diffuse growth,
The pleural thickening, fusion occurred the formation of nodule or mass; for pleural cavity tumor growth could disappear, common bad
Dead and bleeding. Light microscope, mimicking adenocarcinoma tumor cells arranged in papillary, cable strip, adenoid structure. In addition,
Immunohistochemistry in the diagnosis of malignant pleural mesothelioma has an important position.
According to pathological type, epithelioid malignant mesothelioma are divided into type - accounting for 50% to 60%. Common tubular milk
Head shape, and solid sheet adenomatous variant; sarcomatoid type - accounting for 7% to 10%; mixed - containing epithelioid
And sarcomatoid type two components.
■ a variety of treatments simultaneously
Currently, the method of treatment of malignant pleural mesothelioma, including surgery, radiotherapy, chemotherapy and combined multi-disciplinary treatment
Treatment and so on. Professor Liao Meilin them one by one were introduced.
Surgical resection of malignant pleural mesothelioma to achieve the cure for the disease is unlikely, only for early
Patients. The early detection of malignant pleural mesothelioma, diagnosis is difficult, wait until patients are often found when the disease
More than can meet the complete range of surgical resection. The goal of surgery is to relieve symptoms and reduce the tumor load, hand
Surgery often due to lesions involving very wide chest top, apex, mediastinum, and diaphragm flank, and sometimes invading
Abdominal cavity. Currently, thoracoscopic pleural resection not useful (or stripping) procedure clear cut the entire pleural stripping reports
The surgical extrapleural pneumonectomy in patients with resection from the extrapleural tumor en bloc together with the pleura, including the side
Whole lung, pericardium and diaphragm.
Post-operative radiotherapy is the adjuvant therapy of patients in order to reduce the tumor volume, preventing pleural biopsy, pleural
Mirror and the surgical wound after seeding spread. However, due to a wide range of diseases, lung tissue around the tumor was surrounded
Result of chemotherapy is very difficult.
Chemotherapy is mainly used in patients with non-surgical conditions, is the most common treatment of malignant pleural mesothelioma hand
Segment. However, most chemotherapy drugs for the disease remission rate of less than 20%. Currently, Pemetrexed disodium + cisplatin,
In the treatment of malignant pleural mesothelioma has obvious advantages.
Malignant pleural mesothelioma multidisciplinary treatment including surgery, chemotherapy, radiotherapy combined immunodeficiency, gene therapy and
Photodynamic therapy.
There are reports that 14 cases combined with procarbazine radiotherapy, the median survival time was 10.9 months; 33 cases should be
Radiotherapy combined with cyclophosphamide, the median survival time was 10.8 months, while 13 patients received only radiotherapy, the median of Health
Deposit of only 7.8 months.
Malignant pleural mesothelioma, a molecular biology research found that a lot of autocrine tumor growth factor high
Degree of expression of the phenomenon (including angiogenesis factor, epidermal growth factor, cox protein), the study
Who suggested that inhibition of growth factors with the corresponding biological targets for therapeutic drugs, such as vascular endothelial growth factor
(VEGF) receptor tyrosine kinase inhibitor SU5416 (semaxamib) and anti-human anti-VEGF monoclonal antibody
Body, you can block VEGF and its receptors.
There are many of malignant pleural mesothelioma is still in the multidisciplinary treatment of basic or clinical research, human
We look forward to the results of these studies come out as soon as possible.
Raise the survival rate of new treatment modalities
Tumor Hospital, Sun Yat-sen Professor of tension pemetrexed disodium as the advent of watershed, referred to the reporter
Introduce the development of the treatment of malignant pleural mesothelioma. He said the advent of pemetrexed disodium ago, almost all
Chemotherapy of malignant pleural mesothelioma results were negative, and only cisplatin showed 10% to 15%
Response rates, can bring people a little comfort. Pemetrexed disodium come, so that the treatment of malignant pleural mesothelioma
With the first line drugs, which prolong survival in the show on the advantages of reversing the malignant pleural
The plight of the treatment of skin tumors. Professor Zhang Li, respectively, related to these two different periods of study, the selection of a
Representative studies to support his above assessment.
■ poor efficacy of cisplatin alone
In 2002, an international Meta (combined research findings and results of homogeneity test system
Count method) analysis of 1965 to 2001 53 different countries of chemotherapy of malignant pleural mesothelioma
Clinical studies (involving a total of 2320 cases of patients with systemic chemotherapy) were retrospectively reviewed. The study root
According to 2320 cases of different drug in patients, divided into 4 groups. The first group of non-drug cisplatin-doxorubicin; s
Two groups of agents with non-doxorubicin and cisplatin; third group of drugs containing both doxorubicin and cisplatin; fourth group with
Also contain non-drug doxorubicin and cisplatin. Result, the first group is 23% efficient; the second group was 11%;
The third group is 28% efficient; fourth group is 11% efficient. "This shows that the treatment of patients can not
Doxorubicin, but not without cisplatin. Even so, the efficacy of cisplatin is not really encouraging. "Tension
Professor of the Meta analysis, so that journalists have a sense of mountain heavy water.
■ pemetrexed disodium and cisplatin significant clinical advantages
"In 2003, one from the 19 countries, 456 cases showed that the registration of clinical research, training and the U.S.
Qu plug disodium and cisplatin chemotherapy significantly increased in patients with malignant pleural mesothelioma survival. "Soon,
Professor Zhang Li a way out again into the realm of news.
The study began in 1988. Researchers in these 456 cases 448 cases of patients (surgery and should not be missed
By chemotherapy) were divided into two groups: the first group 226 patients were treated with pemetrexed disodium (500 mg / m 2 body surface area
) And cisplatin (75 mg / m 2 body surface area) treatment; second group of 222 patients only treated with cisplatin. Two
Group were administered intravenously.
Initially, the first group had neutropenia, severe diarrhea, dry mouth and other severe lack of vitamin
Lack of toxicity. Subsequently, the researchers added the first group of folic acid and vitamin B12, which significantly reduced
The blood of drug toxicity and gastrointestinal toxicity (including drug-related deaths).
The results show that the first group, the median survival time was 12.1 months, the second group was 9.3 months; s
A group of disease progression was 5.7 months, the second group was 3.9 months; the first group of the effective rate of 41.3%
The second group, 16.7%; to add folic acid and vitamin B12 on the survival time of the first group is not adversely affected; s
A set of quality of life was significantly better in the second group.
Professor Zhang Li said that based on the results of the study in early 2004, the U.S. Food and Drug Administration approval of training U.S.
Qu plug disodium and cisplatin for malignant pleural mesothelioma. In mid-August of this year, access to our national drug
Food and Drug Administration approval, has officially entered China market.
Professor Zhang Li that pemetrexed disodium effect, due to its unique mechanism of action, that it is a
Species can inhibit thymidylate synthase, dihydrofolate reductase, glycine, ribose nucleoside anti-A acyltransferase leaves
Acid metabolism of chemotherapy drugs. It is the process of cell replication by interfering with folic acid-dependent metabolism play a role. This
Kinds of multi-target anti-tumor effect, it was also in Europe and the United States for the treatment of non-small cell lung cancer second-line drugs.
Comprehensive use of imaging techniques improve the diagnosis
Pathology is the microscopic view, looking at macro-imaging. The famous image of China experts, Shanghai East China
Hospital Professor Zhang Guozhen to reporters in the imaging of malignant pleural mesothelioma diagnosis before the first sentence emphasizes
Is to conduct comprehensive diagnosis of the disease. Then, he was a more detailed imaging of the basic features of the disease,
The role of various diagnostic imaging techniques and imaging appear on the reasons for misjudgment were described and analyzed.
■ four key imaging features for diagnosing
"Imaging of malignant pleural mesothelioma have 4 basic characteristics: diffuse pleural thickening of the affected side, accompanied by enhanced Results
Section, and pleural effusion (60%); ipsilateral thoracic pleural contraction and collapse (25%); there chest wall, mediastinum, pericardium,
Ribs, spine and abdominal cavity metastasis (10%); ipsilateral pleural calcification (5%). "Professor Zhang Guozhen Introduction Introduction
Concise Gai. But in the next 4 analyzes the characteristics of this, he repeatedly stressed that special attention on the nodules, the
Imaging studies must be done to enhance the treatment, the tumor if it is found necessary to consider the issue nodules. The extensive pleural
Pan-thickening, and pleural effusion associated with nodules that enhance malignant pleural mesothelioma is a - can have a few nodules,
And a violation of the mediastinum, chest wall. Contraction of ipsilateral pleura and chest images prevalent in the non-collapse exposure to asbestos who suffer from
Had no pleural effusion, enhanced MRI can be seen after a wide range of nodules, and a violation of the mediastinum, pleura, this is the 2 performance.
Images show the chest wall, mediastinum, pericardium, ribs, spine, abdominal metastasis in patients with tumors more than 3 have been suffering from
Severe pain may occur. Pleural calcification of the affected images are often mistaken for clinical tuberculosis, so
Require special attention.
■ Integrated decision to reduce misdiagnosis
Professor Zhang Guozhen pointed out that in the imaging of malignant pleural mesothelioma diagnosis, traditional perspective, and chest X-ray inspection
Charles still can not be ignored, it can be found lesions, and its screening. B-can be used for patients with chest
Pumping fluids and biopsy. CT is the most commonly used for the disease, the most valuable and essential way to check. Enhanced CT scan
Scan can show pleural thickening, pleural nodules, pleural mass, especially in the TNM staging of tumor, CT
The chest was superior. Magnetic resonance imaging (MRI) diagnosis of the disease has important value, that is, the need was
Said chest wall, diaphragm and other fascia involvement, it can be difficult problems to solve as complementary imaging examination
Investigation. Positron emission tomography (PET) as a differential diagnosis of benign and evil nature of the tumor to some extent help
Its main value is for the TNM tumor staging and prognosis evaluation, is to complement other imaging
Charge, not as a routine use. "Uncertainty in the imaging diagnosis, the intervention should be combined with clinical data and puncture
Soft tissue biopsy or thoracoscopic comprehensive judgments, in order to make a diagnosis.
Professor Zhang Guozhen went on to misdiagnosis of patients with malignant pleural mesothelioma cases were analyzed. Patients may be
Misdiagnosed as lung cancer, miliary tuberculosis, tuberculous pleurisy with pleural effusion, pneumothorax, pulmonary tuberculosis, slow
Of lung abscess, pleural metastases and so on.
Professor Zhang Guozhen that led to misdiagnosis of patients was the main clinical symptoms of malignant pleural mesothelioma
No specific, easy and confused the symptoms of the disease; the tumor showed a diversity of imaging performance, some form
Is not easy and lung cancer, tuberculosis, lung abscess and other distinguished; pathological drawn parts are not allowed; doctors were the main
Do not attach importance to such complaints.
Professor Zhang Guozhen suggested that the cytological smears of pleural puncture, find, and nuclei associated with irregular shaped
Is a simple cuboidal or flat epithelial cells, can be combined with the typical radiographic signs of malignant pleural mesothelioma
Make a clinical diagnosis.
Jiujiang reporter Jing
Related links: TNM staging of malignant pleural mesothelioma
▲ T: primary tumor size and scope
T1a, tumor limited to ipsilateral parietal pleura, including mediastinal and diaphragmatic side of the pleura; not involving the visceral pleura.
T1b: Tumor involving the ipsilateral pleural surfaces (including the parietal or mediastinal, diaphragmatic and visceral pleura).
T2, tumor involving the ipsilateral pleural surfaces (including the parietal or mediastinal, diaphragmatic and visceral pleura), at least the next
Out an expression: involvement of the diaphragm; fusion of the visceral pleura (including leaves, split between segments) or breast tumor from the visceral
Membrane invasion of lung parenchyma.
T3, partial resection of extensive lesions but there is the possibility of involving all of the ipsilateral pleural tumor (including the parietal or longitudinal
Septum, diaphragm and visceral pleura), a manifestation of at least the following: involving thoracic fascia; invasion and mediastinal fat;
Isolated, complete resection of the tumor can be, but the soft tissue of chest wall invasion; involvement but did not invade the pericardium and myocardium.
T4, locally extensive disease technically unresectable tumor, all ipsilateral pleural involvement (including the wall
Layer or mediastinal, diaphragmatic and visceral pleura), a manifestation of at least the following: diffuse spread of tumor in the chest wall
Or showed a multifocal tumor, with or without ipsilateral rib destruction; directly through the diaphragm and peritoneal invasion; direct invasion and contralateral
Pleura; direct mediastinal invasion, and one or more organs; direct invasion and spine; tumor invasion and pericardial membrane, with or
Not associated with pericardial effusion, or tumor involving the myocardium.
▲ N: lymph node metastasis
Nx, regional lymph nodes could not be evaluated; N0, no regional lymph node metastasis; N1, metastasis to the ipsilateral bronchial
Lung or hilar lymph nodes; N2, transferred to the subcarinal or ipsilateral mediastinal lymph nodes, including ipsilateral internal mammary lymph nodes;
N3, metastasis to contralateral mediastinal lymph nodes, contralateral breast lymph nodes, ipsilateral or contralateral supraclavicular lymph node.
▲ M: distant metastasis
Mx, distant metastases could not be evaluated; M0, no distant metastasis; M1, distant metastasis;
Phase Ⅰ: Ⅰ a, including T1a, N0, M0; Ⅰ b, including T1b, N0, M0.
Phase Ⅱ: include T2, N0, M0;
Phase Ⅲ: including all T3, M0, N1, M0, N2, M0.
Ⅳ stage: including all T4.
