演題抄録

パネルディスカッション

開催概要
開催回
第56回・2018年・横浜
 

悪性胸膜中皮腫に対する根治的胸膜摘除および胸腔内温熱抗癌剤灌流を含む集学的治療

演題番号 : PD22-4

[筆頭演者]
演者)大久保 憲一:1 
[共同演者]
石橋 洋則:1、小林 正嗣:1、今井 紗智子:1

1:東京医科歯科大学・呼吸器外科

 

Background: Standard treatment for malignant pleural mesothelioma (MPM) is not established. We developed a multimodality protocol including extended pleurectomy/decortication (P/D) for resectable MPM.
Methods: Since 2010, 28 patients with MPM (cT1-3N0-2M0) received a multimodality treatment consisting of P/D & intraoperative hyperthermic intrapleural CDDP perfusion (42℃, CDDP 80mg/m2 in saline 2L, 1hr) and postoperative chemotherapy (CDDP+PEM, 4 cycles). There were 25 men and 3 women with a mean age of 66.6 years (55-76 years). Fourteen patients had a right-side disease. Histological subtypes were epithelioid in 22 biphasic in 5, and desmoplastic in 1, and pathological staging (ver 7) was T1 / 2 / 3 / 4 in 7 / 4 / 12 / 5, and N0 / 1 / 2 in 20 / 0 / 8, respectively. All parietal and visceral pleura were removed, and pericardium and/or diaphragm were resected when necessary. Concentrations of platinum in the perfusate and the serum were analyzed before and after the perfusion in 10 patients. Acute surgical outcome, survivals and relapse patterns were examined.
Results: All patients obtained macroscopic complete resection with no 90-day mortality. Twenty-six patients received multiple cycles of chemotherapy. Concentrations of platinum showed that 72% of CDDP was collected after intrapleural perfusion, and the concentration of platinum in the perfusate was 30 times higher than that in the serum (27μg/ml vs 0.9μg/ml). Median survival was 36 months, and 2- and 5-year overall survivals were 80% and 32%, respectively. Median disease free survival (DFS) was 24 months, and 2- and 5-years DFSs were 44% and 29%, respectively. First relapse sites indicated that 9 of 12 relapses were locoregional and 3 were both locoregional and distant.
Conclusions: P/D and intraoperative hyperthermic CDDP perfusion followed by systemic chemotherapy for MPM is promising. Relapse patterns revealed the majority was locoregioal failure, and better local control would prolong survival.

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