Pleural malignancies represent a clinically devastating group of oncological disorders, most commonly arising from metastatic disease, with lung and breast cancers being the most frequent primary sites. Malignant pleural mesothelioma is a primary malignancy of the pleura and occurs less often than metastatic pleural disease. Pleural malignancies often present with malignant pleural effusion, which typically indicates advanced-stage disease and is associated with poor overall prognosis. Treatment of pleural malignancies includes both palliative and definitive approaches. Palliative interventions primarily aim to relieve symptoms and improve quality of life. Definitive treatments include systemic chemotherapy, targeted therapy, and immunotherapy, depending on the type and molecular profile of the underlying tumor. In mesothelioma, platinum-based chemotherapy in combination with pemetrexed remains the cornerstone of treatment, while the combination of nivolumab and ipilimumab is recommended as first-line therapy for unresectable disease. For metastatic disease, systemic therapy is typically tailored to the primary tumor’s characteristics. Intrapleural administration of chemotherapeutic agents is one of the therapeutic strategies and hyperthermic intrathoracic chemotherapy and pressurized intrathoracic aerosol chemotherapy are the most recent innovations that are under active investigation. This review provides an up-to-date synthesis of systemic chemotherapy strategies for pleural malignancies, their integration with targeted and immune-based therapies, and recent advances in intrapleural chemotherapy modalities. It also explores existing knowledge gaps and outlines directions for future research and potential changes in clinical practice.
胸膜恶性肿瘤是一类临床预后极差的肿瘤性疾病，最常见于转移性病变，其中肺癌和乳腺癌是最常见的原发部位。恶性胸膜间皮瘤是胸膜的原发性恶性肿瘤，其发生率低于转移性胸膜疾病。胸膜恶性肿瘤常表现为恶性胸腔积液，这通常提示疾病已进入晚期阶段，且与总体不良预后相关。胸膜恶性肿瘤的治疗包括姑息性和根治性两种策略。姑息性干预主要旨在缓解症状并提高生活质量。根治性治疗则包括全身化疗、靶向治疗和免疫治疗，具体方案取决于原发肿瘤的类型和分子特征。对于间皮瘤，以铂类药物联合培美曲塞为基础的化疗仍是治疗的基石，而纳武利尤单抗联合伊匹木单抗被推荐作为不可切除疾病的一线治疗方案。对于转移性疾病，全身治疗方案通常根据原发肿瘤的特征进行个体化制定。胸腔内化疗是治疗策略之一，其中热灌注胸腔内化疗和加压胸腔内气溶胶化疗是最新研发且正在积极研究中的创新技术。本综述系统阐述了胸膜恶性肿瘤全身化疗策略的最新进展、其与靶向及免疫治疗的联合应用，以及胸腔内化疗模式的最新研究动态，同时探讨了当前认知的局限性，并对未来研究方向及临床实践可能发生的变革进行了展望。
肿瘤(癌症)患者之家