培美曲塞与卡铂静脉化疗联合榄香烯乳胸腔灌注治疗恶性胸膜间皮瘤的临床观察

目的　评价培美曲塞与卡铂化疗同时联合榄香烯乳胸腔灌注治疗恶性胸膜间皮瘤（ＭＰＭ）合并胸腔积液的疗效与安全性。方法　回顾性分析１５例ＭＰＭ合并胸腔积液患者的临床资料，具体用药：培美曲塞５００ｍｇ／ｍ２，ｄ１；卡铂（ＡＵＣ＝５）ｄ２，每２１天重复；同时引流尽胸腔积液，榄香烯乳２００ｍｇ／ｍ２胸腔注入，ｄ１或ｄ８。结果　１５例患者中，１３例（８６.７％）胸腔积液得到控制，１０例（６６.７％）胸腔积液癌细胞检查由阳性转为阴性；获ＣＲ４例，ＰＲ６例，ＳＤ３例，ＰＤ２例；总有效率为６６.７％，疾病控制率为８６.７％，中位无进展时间为５.０个月，中位总生存时间为１１.１个月，１年生存率为３６.０％。主要毒副反应为骨髓抑制、发热、胸痛、皮疹，多为１～２级，支持对症处理后均可恢复。结论　培美曲塞联合卡铂化疗同时榄香烯乳胸腔灌注治疗ＭＰＭ合并胸腔积液有较好的疗效，毒副反应轻，值得临床推广应用。

Clinical study of pemetrexed combined with carboplatin and elemene by intrathoracic perfusion treatment on 15 cases of malignant pleural mesothelioma with pleurorrhea

Objective To evaluate the efficacy and safety of pemetrexed combined with carboplatin chemotherapy and elemene by intrathoracic perfusion for malignant pleural mesothelioma（MPM） with pleurorrhea.Methods A total of 15 patients with MPM pleurorrhea were analyzed retrospectively in this study.These patients were treated with systemic chemotherapy of pemetrexed and carboplatin.Pemetrexed was administered at the dose of 500mg/m2,iv,day 1;carboplatin AUC=5 was given,iv,day 2;every 21 days was a cycle.Elemene 200mg/m2 was applied by intrathoracic perfusion after the pleural effusion was dviven off.Results 13（86.7%）patients with pleurorrhea was controlled in 15 patients and there was 10（66.7%）patients whose cancer cell in pleurorrhea turned into negative.In 15 patients there were 4 complete remission,6 partial responses,3 stable disease and 2 progressive diseases.The total response rate was 66.7%,the disease control rate was 86.7%,the median progression-free survival was 5.0 months,and the median survival time was 11.1 months.The 1-year survival rate was 36.0%.The major grade 1-2 toxicities were myelosuppression,fever,chest pain and skin rash which could be recovered by symptomatic treatments.Conclusion It is effective and safe for the regiments of pemetrexed combined with carboplatin and elemene by intrathoracic perfusion to cure MPM with pleurorrhea.The clinical application should be approached extensively.