奈达铂在恶性胸腔积液胸腔热灌注化疗中的应用

  目的  探讨奈达铂胸腔热灌注化疗治疗恶性胸腔积液的疗效及不良反应。  方法  将33例恶性胸腔积液患者随机分两组进行治疗, 所有患者全部行胸腔置管引流术, 胸腔积液引流干净后行胸腔热灌注化疗, A组(奈达铂组)19例, 注入奈达铂80mg, B组(顺铂组)14例, 注入顺铂80mg, 并注意预防和处理治疗毒副反应。  结果  A组有效率89.5%, B组有效率85.7%, 两组比较无显著性差异, 两组在骨髓抑制、肝肾功能损害方面比较无显著性差异, 但在胃肠道反应方面, 奈达铂组(10.5%)较顺铂组(42.9%)低, 两组比较有显著性差异, 且奈达铂无需水化、利尿等处理。  结论  奈达铂应用于体腔热灌注化疗治疗恶性胸腔积液疗效肯定, 毒副反应低, 安全性好, 无需水化、利尿等, 临床使用方便, 有临床应用价值。      

胸腔灌注奈达铂与顺铂治疗非小细胞肺癌恶性胸腔积液的疗效比较

目的 观察胸腔灌注奈达铂(NDP)与顺铂(DDP)治疗非小细胞肺癌(NSCLC)恶性胸腔积液的疗效、患者的牛活质量及毒副反应.方法 68例确诊为NSCLC(湿性Ⅲb期)的患者,经胸腔置管引流术排尽积液后,随机分为NDP组和DDP组,每组34例.NDP组采用NDP 40 mg/m2和氟美松10 mg溶于40 ml生理盐水,胸腔内灌注;DDP组采用DDP 40 mg/m2和氟美松10 mg溶于40 ml生理盐水,胸腔内灌注.每周1次,连续2～4周.两组患者均给予相同常规支持对症治疗,观察并比较各组的疗效、毒副反应及患者的生活质量.结果 NDP组有效率为88.2%,DDP组有效率为61.7%(P<0.01).NDP组消化道不良反应发生率为5.0%,DDP组消化道不良反应发生率为12.9%,差异有统计学意义(P<0.05).NDP组的Karnofsky评分较DDP组有显著提高(P<0.05),NDP组的患者生存期较DDP组显著延长.结论 NDP胸腔灌注治疗NSCLC引起的恶性胸腔积液是一种有效且毒副反应轻的方法 .     

胸腔灌注奈达铂与顺铂治疗非小细胞肺癌恶性胸腔积液的疗效比较

目的 观察胸腔灌注奈达铂(NDP)与顺铂(DDP)治疗非小细胞肺癌(NSCLC)恶性胸腔积液的疗效、患者的牛活质量及毒副反应.方法 68例确诊为NSCLC(湿性Ⅲb期)的患者,经胸腔置管引流术排尽积液后,随机分为NDP组和DDP组,每组34例.NDP组采用NDP 40 mg/m2和氟美松10 mg溶于40 ml生理盐水,胸腔内灌注;DDP组采用DDP 40 mg/m2和氟美松10 mg溶于40 ml生理盐水,胸腔内灌注.每周1次,连续2～4周.两组患者均给予相同常规支持对症治疗,观察并比较各组的疗效、毒副反应及患者的生活质量.结果 NDP组有效率为88.2%,DDP组有效率为61.7%(P<0.01).NDP组消化道不良反应发生率为5.0%,DDP组消化道不良反应发生率为12.9%,差异有统计学意义(P<0.05).NDP组的Karnofsky评分较DDP组有显著提高(P<0.05),NDP组的患者生存期较DDP组显著延长.结论 NDP胸腔灌注治疗NSCLC引起的恶性胸腔积液是一种有效且毒副反应轻的方法 .     

胸腔灌注奈达铂与顺铂治疗非小细胞肺癌恶性胸腔积液的疗效比较

目的 观察胸腔灌注奈达铂(NDP)与顺铂(DDP)治疗非小细胞肺癌(NSCLC)恶性胸腔积液的疗效、患者的牛活质量及毒副反应.方法 68例确诊为NSCLC(湿性Ⅲb期)的患者,经胸腔置管引流术排尽积液后,随机分为NDP组和DDP组,每组34例.NDP组采用NDP 40 mg/m2和氟美松10 mg溶于40 ml生理盐水,胸腔内灌注;DDP组采用DDP 40 mg/m2和氟美松10 mg溶于40 ml生理盐水,胸腔内灌注.每周1次,连续2～4周.两组患者均给予相同常规支持对症治疗,观察并比较各组的疗效、毒副反应及患者的生活质量.结果 NDP组有效率为88.2%,DDP组有效率为61.7%(P<0.01).NDP组消化道不良反应发生率为5.0%,DDP组消化道不良反应发生率为12.9%,差异有统计学意义(P<0.05).NDP组的Karnofsky评分较DDP组有显著提高(P<0.05),NDP组的患者生存期较DDP组显著延长.结论 NDP胸腔灌注治疗NSCLC引起的恶性胸腔积液是一种有效且毒副反应轻的方法 .     

奈达铂腔内灌注治疗肺癌胸腔积液的临床观察

目的：观察奈达铂胸腔灌注治疗肺癌胸腔积液的临床疗效及安全性.方法：确诊为肺癌恶性胸腔积液的患者56例,分为2组.采用中心静脉导管胸腔闭式引流排尽胸水后,治疗组29例,给予胸腔灌注奈达铂治疗,对照组27例,给予胸腔灌注顺铂治疗.胸腔内注射间歇5-7天1次,共计不超过3次.结果：治疗组控制胸水的有效率68.9%,对照组59.2%（P＞0.05）.治疗组生活质量的有效率72.4%,对照组59.2%（P＜0.05）.毒副反应方面,治疗组在恶心、呕吐,胸痛,疲乏感方面的发生率低于对照组（P＜0.05）.结论：奈达铂腔内灌注治疗肺癌恶性胸腔积液,疗效可靠,不良反应较轻,安全性较高.     

恩度联合奈达铂胸腔内灌注治疗恶性胸腔积液疗效观察

目的探讨恩度联合奈达铂胸腔内灌注治疗恶性胸腔积液的有效性和安全性。方法将60例恶性胸腔积液患者随机分为试验组和对照组,2组患者均先采用胸腔穿刺置管闭式引流胸腔积液,试验组30例采用恩度（45mg）联合奈达铂（40mg）进行胸腔内灌注,而对照组30例仅采用奈达铂（40mg）进行胸腔内灌注,观察2组的疗效和毒副反应。结果试验组有效率为76．67％,优于对照组的36．67％,差异有统计学意义（P〈0．05）;2组主要毒副反应发生率比较差异无统计学意义（P均〉0．05）;试验组生活质量改善率为73．33％,高于对照组的43．33％,差异有统计学意义（P〈0．05）。结论恩度联合奈达铂胸腔内灌注治疗恶性胸腔积液安全有效。     

奈达铂腔内灌注联合热疗治疗肺癌胸腔积液的临床观察

目的:观察奈达铂胸腔灌注联合热疗治疗肺癌胸腔积液的疗效、生活质量和不良反应。方法:确诊为肺癌恶性胸腔积液的患者50例,随机分成两组,采用中心静脉导管胸腔闭式引流排尽胸水后,A组(26例)给予胸腔灌注奈达铂化疗,随后进行患侧胸腔深部热疗;B组(24例)只给予胸腔灌注奈达铂化疗。结果:A组控制胸水的有效率为88.4%,B组为62.5%(P<0.05);A组与B组的生活质量好转率分别为84.6%和50.0%(P<0.05)。结论:采用热疗联合奈达铂胸腔灌注治疗肺癌恶性胸腔积液疗效确切,不良反应小,安全性高。     

奈达铂腔内灌注联合热疗治疗肺癌胸腔积液的临床观察

目的：观察奈达铂胸腔灌注联合热疗治疗肺癌胸腔积液的疗效、生活质量和不良反应。方法：确诊为肺癌恶性胸腔积液的患者50例,随机分成两组,采用中心静脉导管胸腔闭式引流排尽胸水后,A组（26例）给予胸腔灌注奈达铂化疗,随后进行患侧胸腔深部热疗;B组（24例）只给予胸腔灌注奈达铂化疗。结果：A组控制胸水的有效率为88.4%,B组为62.5%（P〈0.05）;A组与B组的生活质量好转率分别为84.6%和50.0%（P〈0.05）。结论：采用热疗联合奈达铂胸腔灌注治疗肺癌恶性胸腔积液疗效确切,不良反应小,安全性高。     

奈达铂胸腔灌注治疗恶性胸水的临床观察

目的：观察胸腔内注射奈达铂（ＮＤＰ）和顺铂（ＤＤＰ）治疗恶性胸水的疗效。方法：收集６１例晚期各种肿瘤引起的恶性胸水患者,随机分为ＮＤＰ组和ＤＤＰ组,两组患者均先排尽胸水,ＮＤＰ组采用ＮＤＰ（１００ｍｇ／次）溶于２０～４０ｍｌ生理盐水中注入胸腔,ＤＤＰ组用ＤＤＰ（８０ｍｇ／次）溶于２０～４０ｍｌ生理盐水中注入胸腔,观察两组胸水治疗的有效率、胸水复发时间,以及患者生存质量变化和中位生存时间。结果：ＮＤＰ组治疗胸水有效率８０.０％,优于ＤＤＰ组５４.５％（Ｐ＝０.０１２）;呼吸困难缓解程度ＶＡＳ评分ＮＤＰ组优于ＤＤＰ组（Ｐ＜０.０５）;中位生存期ＮＤＰ组４１３天,ＤＤＰ组４０４天,两组无统计学差异。结论：ＮＤＰ治疗恶性胸水安全有效,其治疗效果优于顺铂。     

胸腔热灌注化疗治疗肺癌胸腔积液的临床观察

目的 观察胸腔热灌注化疗对比胸腔置管化疗治疗肺癌所致恶性胸腔积液的临床疗效及不良反应.方法 纳入103例肺癌胸腔积液患者,胸腔热灌注化疗组65例,胸腔置管化疗组38例.观察胸腔积液控制率、胸腔积液进展时间、胸腔积液中血管内皮生长因子(VEGF)浓度与疗效的关系以及不良反应发生情况.结果 热灌注化疗组和置管化疗组的胸腔积液控制率分别为81.5％和52.6％,差异有统计学意义(x2=9.834,P=0.002).两组患者的中位胸腔积液进展时间分别为3.10个月和2.15个月,差异有统计学意义(x2=10.512,P=0.001).胸腔积液中VEGF低浓度患者接受胸腔热灌注化疗和腔内置管化疗后的中位胸腔积液进展时间分别为3.34个月和2.20个月,差异有统计学意义(x2=9.409,P=0.002),但VEGF高浓度亚组,两种治疗方法的中位胸腔积液进展时间分别为2.85个月和2.10个月,差异无统计学意义(x2=2.429,P=0.119).两组患者的不良反应主要为消化道不良反应、乏力及血液毒性,热灌注化疗组患者乏力较置管化疗组常见(67.7％∶13.2％;x2 =28.595,P＜0.001).结论 胸腔热灌注化疗治疗肺癌所致恶性胸腔积液较常规腔内置管化疗提高了胸腔积液控制率,且可延长胸腔积液进展时间,不良反应易于耐受,胸腔积液进展时间延长在胸腔积液VEGF低浓度亚组中尤为明显,VEGF可作为胸腔热灌注化疗的疗效预测因素.     

The clinical significance of malignant pleural effusions in patients with optimally debulked ovarian carcinoma

BACKGROUND: The objective of this study was to determine the impact of malignant pleural effusions on survival in patients with optimally debulked, advanced epithelial ovarian carcinoma. METHODS: The authors conducted a retrospective review of all patients with advanced epithelial ovarian carcinoma who underwent optimal primary cytoreduction at their institution between January 1987 and August 2000. Survival rates were compared between patients with optimally debulked Stage IIIC epithelial ovarian carcinoma and patients with optimally debulked Stage IV epithelial ovarian carcinoma (according to the International Federation of Gynecology and Obstetrics [FIGO] staging system) based on cytology-proven malignant pleural effusions. RESULTS: Ninety-nine patients were identified, and 97 of those patients were evaluable. The group with Stage IIIC disease included 76 patients, and the group with Stage IV disease included 21 patients. The median age at diagnosis was 55 years (range, 26-88 years). The majority of patients received platinum-based chemotherapy after undergoing optimal primary cytoreduction. Age, tumor grade and histology, and the percentage of patients with ascites were similar in the two groups. The median survival rate was 58 months for patients who had Stage IIIC disease and 30 months for patients who had Stage IV disease (P = 0.016). CONCLUSIONS: Although both groups underwent optimal cytoreduction in the abdomen/pelvis and were treated in a similar fashion, the median survival rate of patients with malignant pleural effusions was significantly shorter than the survival of patients without effusions. Many factors that led to or were manifested by pleural effusions, such as undetected bulky residual intrathoracic disease, may have been the cause for this survival difference. In the patients with effusions, one or more of these contributing factors may have led to the observed decreased survival rate, warranting further investigation.     

Diagnostic value of pleural interleukin 17 and carcinoembryonic antigen in lung cancer patients with malignant pleural effusions

Interleukin 17 (IL-17) has been found to be increased in some human cancers; however, the possible implication of IL-17 in regulating antitumor responses in lung cancer patients with malignant pleural effusions (MPE) remains to be elucidated. This study aimed to investigate the diagnostic value of pleural IL-17 and carcinoembryonic antigen (CEA) in MPE and benign pleural effusions (BPE). Pleural effusion samples from 108 patients were classified on the basis of diagnosis as MPE (n?=?56) and BPE (n?=?52). The concentration of IL-17 was determined by enzyme-linked immunosorbent assay (ELISA). The CEA levels were also determined in all patients. A significant difference was observed in the levels of CEA (P?<?0.01) between MPE and BPE. The concentration of IL-17 in MPE was significantly higher compared to that in BPE (P?<?0.01). With a cutoff point of 15.7 pg/ml, IL-17 had a sensitivity of 76.8 % and a specificity of 80.8 % for differential diagnosis. The combined detection of IL-17 and CEA had a sensitivity of 96.4 % and a specificity of 92.3 % to distinguish MPE from BPE. The combined detection of IL-17 and CEA may be more valuable in the differential diagnosis between MPE and BPE.     

T- and B-cell responses in patients with malignant pleural effusions.

Lymphocytes of lymphocyte-rich pleural effusions and venous blood from 16 cancer patients, 7 patients with benign pleural effusions and blood from 23 normal blood donors, were examined for cytological features, rosette-forming capacity, immunofluorescent staining, and PHA-stimulated DNA synthesis. Total protein and immunoglobulin levels were also determined. Metastatic effusions revealed approximately 40% higher content of immunoglobulins G, A and M (P less than 0.002) as well as of total protein (P less than 0.005) than non-metastatic pleural effusions. However, the serum of the non-cancer patients contained approximately 50% higher level of Ig than in cancer patients (P less than 0.001). Whilst there was no significant difference in the relative T- or B-cell contents of pleural effusions between cancer and non-cancer patients (P greater than 0.05) spontaneous proliferation of lymphocytes was significantly increased (P greater than 0.01), which led to a lower PHA-stimulated transformation index in pleural effusions from cancer patients than in all other lymphocyte sources examined (P less than 0.001).     

A phase I clinical and pharmacokinetic study of paclitaxel liposome infused in non-small cell lung cancer patients with malignant pleural effusions

PurposeTo investigate the feasibility, pharmacokinetics, efficacy and toxicity of intrapleural paclitaxel liposome injection in non-small cell lung cancer (NSCLC) patients with malignant pleural effusions.Patients and methodsTwelve of 15 NSCLC patients with malignant pleural effusions were treated with paclitaxel liposome and three were treated with free paclitaxel. Adequate pleural fluid, blood and urine were collected for pharmacokinetic study. The clinical efficacy and toxicity were synthetically evaluated according to the correlative criteria.ResultsThe overall toxicity of paclitaxel liposome was lower than that of free paclitaxel. In the patients treated with paclitaxel liposome, there were minimal local chest pain, anaphylaxis, anaemia, neutropaenia and hepatotoxicity. The complete response rates of pleural effusion at the first, second, third and sixth month were, respectively, 27.3%, 18.2%, 9.1% and 9.1%, and overall response rates were 90.9%, 72.7%, 63.6% and 54.5%, respectively. Pharmacokinetic study showed that mean C_max,IP, T_1/2 and AUC_0→96,IP in pleural fluid were, respectively, about 2-fold, 2-fold and 2.5-fold than those of free paclitaxel, and AUC_0→96,Pla in plasma was also much higher than that of free paclitaxel, however, excretory rate in 24 h from urine was lower than that of free paclitaxel.ConclusionsThis study demonstrated that paclitaxel liposome was a more useful agent than free paclitaxel for the treatment of malignant pleural effusions because of its relatively low toxicity and distinct pharmacokinetic characteristics. The phase II study of a large number of patients was recommended to confirm this finding.     

贝伐单抗联合化疗在非小细胞肺癌恶性胸腔积液患者中的应用效果

目的探讨贝伐单抗联合化疗在治疗非小细胞肺癌合并恶性胸腔积液患者中的临床应用效果。方法选取2013年1月至2016年6月间青岛市中心医院收治的86例非小细胞肺癌合并恶性胸腔积液患者为研究对象,采用随机数表法分成两组,每组43例,其中,观察组患者在常规化疗基础上添加贝伐单抗联合治疗,对照组患者接受常规化疗。比较两组患者的治疗效果,同时对患者治疗过程中发现的蛋白尿、高血压、发热、疼痛和脱发等不良反应情况进行统计,并将不良反应按照从大到小严重程度分为Ⅰ级、Ⅱ级、Ⅲ级和Ⅳ级不良反应。结果观察组患者总有效率为74.4%,较对照组患者总有效率51.2%高,差异有统计学意义(P<0.05)。观察组Ⅳ级不良反应发生率少于对照组,差异有统计学意义(P<0.05)。结论贝伐单抗联合化疗治疗非小细胞肺癌合并恶性胸腔积液患者有显著效果,能有效减少恶性胸腔积液的产生,较大程度减少患者不良反应的发生情况,适合临床推广。