Malignant mesothelioma

Mesothelioma as a malignant tumor was first described in 1870, more frequent failure plev-market than the peritoneum, with a predominance of pravostoronney localization. Men get sick more often than women, with respect, 8:1. Mesothelioma may occur at any age, even among children 2-4 years old. In the etiology of mesothelioma main importance is the duration of contact with asbestos and mineral erionitom used in construction practice. Etiological factor considered to be a genetic predisposition, as well as the simian virus SV40.

According to the WHO histologic classification (1999), malignant mesothelioma are divided into epitelial items, sarkomatoidnye and mixed (bifaznye). The most frequent adverse is sarcoma-toidny version of the tumor. Effusion in the pleural cavity may be in 60-80% of patients, but the growth of tumors can cause the complete obliteration of pleural cavity.

The forecast in the pleura mesothelioma unfavorable, the median survival time (when symptomatic therapy) is 7 months.

Surgical treatment of plevrektomy or plevropnevmonektomy a rare, with localized forms, only 7-10% of patients. After plevropnevmonektomy operating mortality reaches 14-15%, far exceeding the (minimum) plevrektomy mortality. Indicators of a long-tion of life after these operations, little different: the median survival in line with 9-21 months. 2-year survival rate is 11-45% (Giaccone G., 2002; Rahman M. Et al., 2003). Improving the long-term results of surgical treatment (primarily plevropnevmonektomy) associated with adjuvant chemotherapy.

The experience of surgery, combined treatment (surgery + chemotherapy + radiotherapy) helped to develop the following recommendations in the pleura mesothelioma: Performing ekstraplevralnoy pneumoectomy (plevropnevmonektomii), through a 4-6 weeks to 6 cycles of chemotherapy drugs with the appointment of platinum, followed by radiotherapy in the area Remote lung and mediastinum. Direct mortality, in different groups of comparison, was 5-22%, median survival - 21 months., 2-5-year survival - 45 and 22% respectively. The factors most favorable prognosis are the type of epithelial tumors, as well as the absence of metastasis.

Radiation therapy (ODS to 50 Gy.) Leads to a reduction in pain, but does not increase life expectancy (increasing doses, as well as a combination of radiation and chemotherapy does not increase the survival rate).

The effectiveness of modern drugs in the pleura mesothelioma rarely exceeds 20%. Marked tumor regression and objective improvement in the application of cisplatin, cycloplatam, mitomycine, raltitreksida (tomudeksa), etoposide, karboplatina, ifosfamida, vinorelbina, gemtsitabina (gemzara) pemetrekseda (alimty).

Combination chemotherapy is carried out as follows: doxorubicin + CYCLOPHOSPHAMIDE, doxorubicin + ifosfamid, doxorubicin + cisplatin + - mitomycine C kampto + cisplatin + mitomycine C gemtsitabin + cisplatin (karboplatin) gemtsitabin + alimta, alimta + cisplatin (karboplatin). Last 3 schemes are considered the standard treatment pleura mesothelioma.

If there is effusion in the pleural cavity may intrapleural introduction of cytostatic drugs or biotherapy to stop or slow the accumulation of exudation. To do this, apply cisplatin, bleomycin, as well - interferon and interleukin-2. Features of photodynamic therapy are studied.

In addition, undergoing clinical trials targetnye drugs: avastin, iressa, glivek, thalidomide, etc., which can increase the survival rate. Among targetnyh drugs should be given to the inhibitors of vascular endothelial growth factor. It is noted that the pleura mesothelioma at a high level of expression of vascular endothelial growth factor correlates with higher density of capillaries and low survival. In this regard, with mesothelioma studied semaksanib, bevatsizumab (Awa-Steen) and thalidomide.