Advances in diagnosis and treatment of malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is an aggressive but relatively rare malignancy with median survival ranging from 8 to 14 months depending on stage and presentation of disease. New diagnostic procedures are urgently needed, selecting patients in earlier stages to evaluate therapeutic approaches which combine chemotherapy, surgery and radiotherapy. Combination chemotherapy represents the only resource available for advanced disease. The combination of cisplatin and pemetrexed is the treatment of choice. This review summarizes the latest developments in diagnostic techniques and the available therapeutic options for the management of MPM. Particular attention is given to the molecular basis of biologically targeted therapies to be used in the future.     

Clinical analysis of 19 patients with pleural mesothelioma

Innumber,4173patientswhosufferedfromrespiratorydiseasewerehospitalizedintheDepartmentofRespiratoryMedicinefromJune1992toOctober1997including304patientswithpleuraleffusion.Amongthem,therewere19patientswithpleuralmesotheliloma,whichaccountedfor0.5%ofthetotalor6.2%ofthepatientswithpleuraleffusion.CLINICALDATAGeneraldataAllofthe19caseswerediagnosedwiththoracoscopicbiopsy;13patientsweremales,and6werefemales.Theiragesrangedfrom22to73years,withanaverageof50.8years.Thehistoryoftheirdiseaserang…     

恶性胸腔积液肿瘤标志物

许多方法和指标都曾尝试用于恶性胸腔积液的诊断,各有利弊。随着分子生物学和实验技术的迅速发展,新的诊断指标和检测方法不断涌现。现根据近年来相关的临床研究结果,对各种肿瘤标志物进行客观评价。     

恶性胸腔积液肿瘤标志物

许多方法和指标都曾尝试用于恶性胸腔积液的诊断,各有利弊。随着分子生物学和实验技术的迅速发展,新的诊断指标和检测方法不断涌现。现根据近年来相关的临床研究结果,对各种肿瘤标志物进行客观评价。     

可弯曲内科胸腔镜在恶性胸腔积液中的诊断价值

目的:评估可弯曲内科胸腔镜在恶性胸腔积液诊断中的应用价值。方法:对2007年10月-2010年6月的32例恶性胸腔积液患者行可弯曲内科胸腔镜检查的结果进行回顾性分析。所有患者在行内科胸腔镜检查前,其胸腔积液常规、生化、微生物学及细胞学等实验室检查均未能明确病因。结果:32例恶性胸腔积液患者中肺癌28例(腺癌22例、低分化癌6例),淋巴瘤2例,恶性胸膜间皮瘤2例。术后发热1例,未发生其他严重不良事件。结论:可弯曲内科胸腔镜是一种操作简便、安全而有效的诊断方法。对经其他常规检查无法明确诊断,且临床不能排除恶性胸腔积液时,应及时行内科胸腔镜检查以明确诊断。     

恶性胸腔积液治疗进展

恶性胸腔积液是由肺癌等恶性肿瘤侵犯胸膜或胸膜原发性肿瘤所致,是晚期恶性肿瘤的并发症,如不及时治疗,平均生存期仅有数月.如何进行有效的治疗对提高患者生活质量、延长生存期有重要意义.     

平阳霉素治疗恶性胸腔积液的临床观察

目的观察平阳霉素治疗恶性胸腔积液的疗效。方法经病理或细胞学证实的恶性胸水患者168例,尽量抽尽胸水后胸腔内注入平阳霉素40 mg/m2 生理盐水20 ml,视胸水多少,5~7 d后再重复治疗。结果恶性胸水患者168例,CR 81例(48.2%),PR 47例(28.0%),NC 40例(23.8%),总有效率为76.2%。结论平阳霉素是治疗恶性胸腔积液的有效药物之一。     

黏质沙雷氏菌苗治疗恶性胸腔积液的临床研究

目的 评价黏质沙雷氏菌苗（S311）治疗恶性胸腔积液的疗效及毒副反应。方法 取S311 10^9U(0.32mg)于第1,8,15天注入胸腔。观察4周,评价疗效和毒副反应。结果 34例患者中,完全缓解（CR）12例,部分缓解（PR）21例,总有效率97.1%(33/34)。毒副反应较轻,有发热（82．4％）、胸痛（52．9％）、恶心（26．5％）、呼吸困难（17．5％）、寒战（5．9％）及呕吐（2．9％）。结论 S311治疗恶性胸腔积液疗效较好,毒副反应可以耐受,可以安全用于临床。     

MAGE基因mRNA在良、恶性胸腔积液中的表达

背景与目的MAGE基因是肿瘤特异性基因。本研究的目的是探讨检测MAGE基因诊断良、恶性胸腔积液的可能性。方法采用RT-PCR方法，检测MAGE-1、-2、-3、-4基因mRNA在40例良、恶性胸腔积液中的表达。结果18例良性胸腔积液中MAGE表达均为阴性。在22例恶性胸腔积液患者中，8例瘤细胞学检查阳性的胸腔积液标本中MAGE表达均为阳性（8／8）；14例胸腔积液查瘤细胞阴性但胸膜活检为阳性者中，11例胸腔积液和胸膜活检标本中MAGE均表达为阳性，另外3例胸腔积液和胸膜活检标本中MAGE均为阴性。结论检测胸腔积液中MAGE基因mRNA的表达，可成为鉴别诊断良、恶性胸腔积液的有效方法之一。     

胸膜全肺切除治疗肺癌胸膜转移伴恶性胸腔积液

背景与目的按肺癌TNM国际分期标准,肺癌胸膜转移伴癌性胸水属于ⅢB期,既往一般采取非手术疗法,但疗效较差,患者的生活质量不高。本研究通过观察胸膜全肺切除的临床应用,来评估治疗ⅢB期肺癌伴胸膜转移和癌性胸水的注意事项和远期效果。方法对1978年12月至2003年2月间采用该术式治疗的55例肺癌伴有胸膜转移、癌性胸水的患者进行总结,定期随访,了解患者生活质量、复发情况和生存时间。计算术后生存率和中位生存时间。结果本组患者中手术死亡2例。患者术后胸闷、呼吸困难、胸腹壁疼痛症状明显缓解,恶病质迅速消失,未见胸水复发,但后期绝大部分患者发生远处脏器转移。随访至2003年8月,出院患者中已死亡48例,生存时间5～40月,平均生存期15个月,中位生存期14个月,仍健在的5例患者术后时间均未超过1年。结论①要严格掌握手术适应证;②手术中要注意肿瘤切除的彻底性;③术中要重视对切口的保护;④手术打破免疫封闭状态,为后续治疗创造条件;⑤患者通过手术可以提高生活质量和中位生存期;⑥患者术后远期生存还不尽如人意。     

胸腔镜对恶性胸腔积液的诊治探讨

目的探讨胸腔镜对恶性胸腔积液的诊治优势.方法对27例恶性胸腔积液患者在胸腔镜辅助下行胸膜活检、固定术.结果所有患者的诊断都得到明确,无一例胸水控制失败,复发5例,术后复张性肺水肿1例.结论胸腔镜对恶性胸腔积液具有良好的诊断价值,且在其辅助下行胸膜固定术有创伤小、效果好等优点.     

博来霉素联合凝血酶对恶性血性胸水的疗效观察

 目的　为了观察博来霉素联合凝血酶对恶性血性胸腔积液的治疗效果。方法　采用胸腔穿刺 ,置入深静脉留置管引流胸腔积液 ,灌注凝血酶 ,并以凝血酶 +博来霉素及博来霉素做对照。结果　凝血酶组2 1例有效率 5 2 .4 % ,凝血酶 +博来霉素组 2 1例 ,有效率 90 .5 % ,而单纯博来霉素组有效率 71.4 % (各组间比较P <0 .0 5 )。结论　凝血酶是一个安全有效抗恶性胸腔积液药物 ,它可安全用于老年人 ,它能增强博来霉素的疗效 ,二者合用能取得更好地抗胸水效果。     

Secretion of intelectin-1 from malignant pleural mesothelioma into pleural effusion

Background:

Malignant pleural mesothelioma (MPM) is a rare but fatal tumour. Although most MPM patients show pleural effusion at even the early stage, it is hard to diagnose as MPM at the early stage because a sensitive and reliable diagnostic marker for MPM has not been found in plasma or pleural effusion.

Methods:

In this study, we investigated whether intelectin-1 was specifically contained in MPM cells and the pleural effusion of MPM patient by immunohistochemistry, western blotting, and enzyme-linked immunosorbent assay.

Results:

Malignant pleural mesothelioma cell lines, but not lung adenocarcinoma cell lines, secreted intelectin-1. In immunohistochemistry, epithelioid-type MPMs, but neither pleura-invading lung adenocarcinomas nor reactive mesothelial cells near the lung adenocarcinomas, were stained with anti-intelectin antibodies. Pleural effusion of MPM patients contained a higher concentration of intelectin-1 than that of lung cancer patients.

Conclusion:

These results suggest that detection of intelectin-1 may be useful for a differential diagnosis of epithelioid-type MPM in immunohistochemistry and that a high concentration of intelectin-1 in pleural effusion can be used as a new marker for clinical diagnosis of MPM.     

Malignant pleural effusion of multiple myeloma: prognostic factors and outcome

Malignant pleural effusion (MPE) in multiple myeloma (MM) is rare. Approximately 80 cases have been reported. To delineate optimal treatment and prognostic variables in these patients, we reviewed 11 MM patients with MPE. MPE developed at median of 12 months from diagnosis of MM. All the patients had high-risk disease based on complex karyotypic abnormalities including deletions of chromosome-13 (n = 9), elevated beta-2 microglobulin (B2M) (n = 9), high C-reactive protein (CRP) (n = 8), high plasma cell labeling index (n = 5) or high LDH (n = 5). A significant increase in B2M, LDH, and CRP was observed at the onset of MPE. The initial diagnosis of MPE was based on positive cytology (n = 9), pleural fluid cIg/DNA (n = 9) or pleural fluid cytogenetics (n = 4). Pleural tissue infiltration was found on pleural biopsy and autopsy in one patient each. Systemic chemotherapy comprising dexamethasone, cyclophosphamide, etoposide and cisplatin (DCEP) (n = 7) and pleurodesis (n = 7) were effective in resolving MPE but survival was short. High dose chemotherapy with peripheral blood stem cell support for MPE in six patients conferred no clear survival advantage. These patients died at median of four months from onset of MPE. Patients with bone marrow complex karyotypic abnormalities including deletion-13 (n = 9) had a shorter (median-18 months) overall survival compared to patients with normal cytogenetics (median-38 months). MPE in patients with MM is often associated with high-risk disease including deletion 13 chromosomal abnormality and heralds a poor prognosis despite aggressive local and systemic treatment.     

Molecular pathways in malignant pleural mesothelioma

Malignant pleural mesothelioma, although uncommon, is highly lethal. There is a high correlation between associated environmental exposure factors, carcinogens, and its development. Carcinogenesis is also mediated by genetic defects that result in loss of tumor suppressors or over expression of proto-oncogenes. Factors such as the loss of CDK inhibition function, IGF stimulatory pathways, p14(ARF), p15(INK4b), p16(INK4a), p21, and p53 loss or mutation, VEGF and COX over expression are discussed. Correlations to potential therapeutic modalities are made.     

Radiotherapy for the treatment of pain in malignant pleural mesothelioma: A systematic review

Radiotherapy is commonly used to treat pain in malignant pleural mesothelioma (MPM). The purpose of this systematic review is to examine the evidence for this practice. Medline (1946–2013), Embase (1974–2013) and Central (The Cochrane Library Issue 9, 2012) databases were searched. Eligible studies met the following criteria: MPM (histological or radiological diagnosis), radiotherapy given with the intent of improving pain, response rates to radiotherapy reported, dose and fractionation reported and the relationship between radiotherapy and pain response explored. All studies had independent review and were graded according to evidence level. Eight studies met the eligibility criteria. Two studies were prospective single arm phase II studies while the remainder were retrospective case series. All were graded as either Level 2 or Level 3 evidence. Due to marked heterogeneity among studies, quantitative synthesis of results was not possible. No high quality evidence currently exists to support radiotherapy in treating pain in MPM. Studies focusing on clear pain endpoints and improving target delineation are needed. Such studies should also use modern radiotherapy techniques and concentrate on dose escalation.     

天地欣腔内注射治疗恶性胸腹腔积液的临床研究

目的:进一步评价国产香菇多糖(天地欣)治疗恶性胸腹腔积液的疗效。方法:在65例(男性31例,女性24例;平均年龄55岁)晚期恶性肿瘤病人排放胸、腹水后,用天地欣4～8mg溶于0.9％氯化钠注射液20ml中,腔内注射。结果:治疗恶性胸、腹腔积液总有效率为61.5％,其中胸腔积液有效率为69.4％,腹腔积液有效率为51.7％。局部及全身毒副作用小。结论:天地欣腔内注射治疗恶性胸、腹腔积液疗效可靠。