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CR 4例,PR 6例,SD 3例,PD 2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.%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.
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