恶性胸膜间皮瘤的治疗进展__培训课件.ppt

Meta for Chemo-conclusion 顺铂+阿霉素是反应率最高的联合化疗方案 (28.5%; P?0.001) 顺铂是最有效的单药. T. Berghmans et al. / Lung Cancer 38 (2002) 111-121 Phase III trial of chemo -Eligibility histologically proven Chemotherapy-naive patients not eligible for curative surgery uni- or bidimensionally measurable disease age 18 years with life expectancy 12 weeks KPS no less than 70. no second primary malignancy no brain metastases excluded if unable to interrupt nonsteroidal anti-inflammatory drugs. Vogelzang NJ, et al.JCO 2003, 21( 14 ): 2636-2644 Vogelzang NJ, et al.JCO 2003, 21( 14 ): 2636-2644 Vogelzang NJ, et al.JCO 2003, 21( 14 ): 2636-2644 Phase III trial of chemo 456 pts : 226 received pemetrexed+ cisplatin, 222 received cisplatin alone, 8 never received therapy. pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 on day 1 in combined group cisplatin 75 mg/m2 on day 1 in PDD only group regimens were given intravenously every 21 days. Vogelzang NJ, et al.JCO 2003, 21( 14 ): 2636-2644 PDD+Alimta（226) PDD （222) P value MST 12.1 m 9.3 m =.022 TTP 5.7 m 3.9 m =.001 RR* 41.3% 16.7% .0001 *:all PR Hazard ratio: 0.77 Phase III trial of chemo Vogelzang NJ, et al.JCO 2003, 21( 14 ): 2636-2644 Vogelzang NJ, et al.JCO 2003, 21( 14 ): 2636-2644 Vogelzang NJ, et al.JCO 2003, 21( 14 ): 2636-2644 化学治疗 MPM对化疗敏感性不佳，大多数化疗方案有效率仅10~20% 1个meta： 铂类是最有效的单药 铂类为主的联合方案更优 III期临床：PDD+Alimta优于PDD 证据级别：I 治疗建议级别：A 放射治疗 体外试验表明MPM对放疗敏感 RCT表明预防照射可以明显减少针道/引流口种植发生 传统放疗难以提高剂量 IMRT的出现使得提高剂量的同时不增加乃至降低并发症成为可能 含有放疗的综合治疗可改善生存 放射治疗预防针道种植 胸腔镜检后种植发生率高达45% Boutin C,et al.Cancer 1993;72:389-93. 放疗预防种植—RCT(France) 40pts,(33 male,7 female),20 for radio,20 for surveillance Life expectancy no less than 3 m Received thoracoscopy 1 m after biopsy Puncture sites still visible 28 received chemo,none succeeded Radiotherapy :21Gy/3f/3d,12.5-15Mev-?, 1cm paraffin bolus Boutin c,et al. Chest 1995,108(3),754-758 Chest 1995,108(3),754-758 放疗预防种植—RCT(France) Boutin c,et al. Chest 1995,108(3),754-758 R