Peritoneal mesothelioma chemotherapy

Peritoneal mesothelioma (peritoneal mesothelioma) for the primary in the peritoneal epithelium and mesothelial cancer organizations, clinical rare. Can be categorized as pathological adenomatoid mesothelioma (adenomatoid mesothelioma), cystic mesothelioma (cystic mesothelioma) and malignant mesothelioma (peritoneal malignant mesothelioma, PMM).
Peritoneal mesothelioma (peritoneal mesothelioma) for the primary in the peritoneal epithelium and mesothelial cancer organizations, clinical rare. Can be categorized as pathological adenomatoid mesothelioma (adenomatoid mesothelioma), cystic mesothelioma (cystic mesothelioma) and malignant mesothelioma (peritoneal malignant mesothelioma, PMM). The first two are benign. Cystic mesothelioma more common in women, the cause is unknown, occur in the pelvic or accessories around, showing single or multiple cystic masses; patients often palpable abdominal mass due to the treatment. Malignant peritoneal mesothelioma (PMM) account for about 30% of malignant mesothelioma; its occurrence is closely related with exposure to asbestos, about 5% of patients had history of exposure; asbestos fiber intake by mouth, after translocation through the intestinal wall into the peritoneal and pleural metastasis from disease or from. From exposure to asbestos to diagnosis, the disease incubation period of up to 25 to 40 years. But the domestic 1951 ~ 1993 20 reported in the literature 161 cases of PMM in only 1 case had history of exposure to asbestos. ZHOU Ya-kang and other reported 47 cases of mesothelioma there are eight cases of malignant peritoneal mesothelioma, as well as the author collected two cases have history of exposure to asbestos. In the absence of asbestos-exposed populations, its incidence rate is about 1 person / 1 million person-years may be related to certain viral infections and genetic factors. PMM has reported 1 cases of foreign patients come into contact with more than 40 years ago, thorium dioxide colloid (Thorotrast). PMM often occurs in men over the age of 40. Visceral or parietal peritoneum can suffer from; and tumors can be a direct violation of abdominal and pelvic organs; 50% ~ 70% of patients with lymphatic and / or hematogenous metastasis of liver, kidney, adrenal gland, lung, bone and so on.

Chemotherapy:

To give a systemic anti-cancer chemotherapy drug, the peritoneal cavity less drug distribution. Foreign reports, whether single-agent or combination therapy, systemic chemotherapy, efficiency is only 11% ~ 14%. Combination chemotherapy programs include: DDP + ADM, DDP + CTX + VCR, CTX + VCR + BLM and so on. But many scholars stressed that the chemotherapy does not improve the curative effect. Poulain, etc. In vitro studies of the DDP, CBP and amphotericin B (AmB) in malignant mesothelioma cell lines in cytotoxicity. Cell line exposure to these drugs two hours, six days later --- inhibit the growth curve shows that the concentration of 5 ~ 10mg / L of AmB on sensitive or resistant cell lines to DDP, and CBP can be 50% of growth - inhibitory concentration (IC50) reduced by 5 ~ 10 times. The role of AmB may be associated with a significant increase in the tumor cells to platinum intake, increased intracellular concentration of platinum, platinum enhanced cytotoxic effects. Phosphodiesterase inhibition methylxanthine (phosphodiesterase inhibiting methylxanthines) and AmB had synergistic effect, its own toxicity is weak, and can alleviate the toxicity of AmB kidney. But so far no clinical report of the joint application of these drugs.

2 intraperitoneal chemotherapy in recent years that the intraperitoneal injection drug use can increase local drug concentrations, reducing systemic adverse reactions; not only the eradication of residual tumor tissue after surgery to reduce the recurrence; also allows partial loss surgery patients the opportunity to reduce the mass, ascites reduced, disease has been effectively controlled.

Intra-abdominal and intravenous dose once a dosage similar to or slightly higher than the latter; 1 week later to repeat. According to the disease can be a continuous injection for several weeks. Ito and so can not give one cases of surgical resection of patients with PMM intraperitoneal injection DDP, and the combination of uracil and tegafur, made an unexpected effect: In the 223 days after abdominal mass and ascites disappeared completely. But in the first 8 months after the recurrence of pelvic masses; re-awarded to DDP and camptothecin, the effect is poor. Ma, etc. are heated by continuous hyperthermic peritoneal perfusion (continuous hyperthermic peritoneal perfusion, CHPP) combined local injection of DDP treatment of PPM. The average amount of the initial DDP infusion 120mg/ml (81 ~ 166mg/ml), perfusion flow rate 1.5L/min, the average infusion volume of 5.1L (4 ~ 7L), reperfusion after 90 minutes, measuring intra-abdominal temperature were three 41.5 ℃, 40.5 ℃ and 41.1 ℃. DDP infusion fluid total area under the curve (AUC) for plasma DDP AUC 21-fold, plasma concentrations and systemic DDP when medication is similar. Course of treatment, no significant local adverse reactions, patients are able to tolerate CHPP. Follow-up of 10 months, no one cases of death due to CHPP treatment. Park, also has similar coverage. It seems now, CHPP as good for the treatment of PMM is an effective way.