Local administration of adriamycin (ADM) for malignant pleural effusion and pericardiac effusion in breast cancer

We examined the efficacy, toxicity, and survival rate of patients treated with local administration of adriamycin (ADM) for malignant pleural effusion and pericardial effusion in breast cancer. From May 1996 to December 2002, we injected ADM into the pleural cavity for 21 courses and into the pericardial cavity for 2 courses in 18 patients. Thirteen patients showed CR (including 2 cases were injected into pericardial cavity), 2 PR, and 4 PD, and the overall response rate was 78.9%. Toxicities included nausea/vomiting, elevated fever, chest pain, and so on in 15 patients (83.3%). No severe toxicities, however, were observed. The overall survival rate after the removal of the drainage tube was 42.5% at 1 year and 16.5% at 2 years. The survival in patients with a first recurrence, and CR or PR was significantly better than other patients. We conclude that local administration of ADM is useful for treatment, without severe toxicities, of malignant pleural effusion and pericardial effusion in breast cancer.     

A case report of inflammatory breast cancer effectively treated with cis-platinum

A 50-year-old woman with bilateral inflammatory breast cancer (T4, N1b, M1, Stage IV) underwent right extended radical mastectomy and left modified radical mastectomy following pre-operative administration of carcinostatics (ADM, 5-FU) and irradiation. However, tumor recurrence was observed at the skin and right pleural cavity after the operation. Adriamycin-containing combination chemotherapy and radiation therapy were performed, but no significant response was obtained. CDDP was then administered intravenously at a daily dose of 62.5 mg/m2 at intervals of 60 days. The pleural effusion disappeared and the extent of skin metastasis was reduced, resulting in partial response which lasted for 90 days. The serum CEA level decreased from 13.1 ng/ml to 2.3 ng/ml. As the side effects of this therapy, slight nausea, vomiting and general fatigue were observed. This result suggested that CDDP is an effective drug for inflammatory breast cancer.     

Improvement of quality of life (QOL) and life prolongation by CPT-11 + adriamycin (ADM) therapy: report of 4 cases of non-Hodgkin's lymphoma refractory to conventional chemotherapies

CPT-11 + ADM therapy (CPT-11 40 mg/body x 2 days; Day 1 & 2, combined with ADM 20 to 60 mg/body x 1 day; Day 3) was given to four patients with relapsed and advanced non-Hodgkin's lymphoma, which was refractory to conventional chemotherapies. The symptoms of the patients at the beginning of CPT-11 + ADM therapy were fever (in two cases), dyspnea due to pleural effusion (in two), severe backache (in one), and jaundice with splenomegaly (in one). Their Karnofsky performance scales were 20 or 30%. Soon after the initiation of CPT-11 + ADM therapy, their clinical conditions improved dramatically, and they obtained a partial remission lasting 3.5 to 9 months. During the period of controlling lymphomas by this therapy, all patients had some time at home for 2 to 8 months. The adverse effects were vomiting, diarrhea, neutropenia and thrombocytopenia, but no lethal infection or hemorrhage was seen. We conclude that CPT-11 + ADM therapy is very useful for improvement of QOL and life prolongation of patients with non-Hodgkin's lymphoma, which is refractory to conventional chemotherapies and is even disseminated.     

A pilot clinical trial of vaccination with dendritic cells pulsed with autologous tumor cells derived from malignant pleural effusion in patients with late-stage lung carcinoma

BACKGROUND: The authors conducted a pilot clinical trial to explore the vaccination of patients with late-stage lung carcinoma with dendritic cells (DCs) pulsed with necrotic tumor cells derived from malignant pleural effusion specimens, and to evaluate the antitumor immune response induced by this therapy. METHODS: Autologous DCs were generated by culturing adherent mononuclear cells with interleukin-4 and granulocyte-macrophage-colony-stimulating factor for 7 days. Day-7 DCs were cocultured overnight with autologous necrotic tumor cells derived from pleural effusion specimens to allow internalization of tumor antigens. DCs were then treated with tumor necrosis factor-alpha for 16 hours. The antigen-loaded DCs were injected into each patient's inguinal lymph nodes under sonographic guidance. Eight patients with late-stage nonsmall cell lung carcinoma were treated in this manner. Patients were vaccinated once weekly for 4 weeks and then boosted twice biweekly. RESULTS: The authors found that there was no Grade II/III toxicity and autoimmune response in all patients after intranodal injection of the DC vaccine. Minor to moderate increases in T-cell responses against tumor antigens were observed after DC vaccination in six of eight patients. Five patients had progressive disease. One patient had minor tumor response and two patients had stable disease. The two patients who had longer disease control also had better T-cell responses. CONCLUSIONS: The results indicated that it was feasible to immunize patients with lung carcinoma intranodally with DCs pulsed with necrotic tumor cells enriched from pleural effusion specimens, and this approach may generate T-cell responses and provide clinical benefit in some patients.     

大剂量高聚金葡素胸腔内注射治疗恶性胸水疗效观察

 目的　研究大剂量高聚金葡素(HASL)胸腔内注射治疗恶性胸水的疗 效。方法　将60例恶性胸水患者随机分为2组,分别采用大剂量HASL和 阿霉素(ADM)加顺铂(DDP)胸腔内注射。结果　HASL的总有效率为83%,ADM组 的总有效率为37%,二组比较统计学上有非常显著差异;未发现明显毒副作用。结论 　大剂量HASL疗效优于ADM组     

局部灌注沙培林和羟基喜树碱治疗恶性胸腔积液

[目的]观察沙培林(0K-432)和羟基喜树碱(HCPT)治疗恶性胸腔积液的近期临床疗效。[方法]对62例恶性胸腔积液患者采用胸腔置入贝朗可分裂中心静脉管持续引流，胸腔积液排放完后，给予沙培林5KE胸腔内注入，dl，HCPT30mg胸腔内注入，d2，每周2次，观察临床疗效与不良反应。[结果]沙培林与HCPT联合治疗恶性胸腔积液总有效率为88．7％，主要不良反应为发热和骨髓抑制。[结论]胸穿置管引流局部灌注沙培林和羟基喜树碱治疗恶性胸积液有较好的近期临床疗效，毒副反应可以耐受。     

温热疗法加局部化疗治疗恶性胸腔积液的疗效观察

目的:观察温热疗法加局部化疗治疗恶性胸腔积液的疗效、生存质量和不良反应。方法:确诊为肺腺癌所致的恶性胸腔积液45例,随机分为两组,尽可能排尽胸水后,A组采用加热至45℃的生理盐水做胸腔内循环灌注,30分钟后局部注入顺铂40mg;B组直接胸腔内注入顺铂40mg。每周重复1～2次,1个疗程2周,观察短期疗效、生存质量及不良反应。结果:A组总有效率为82.6%,B组为50.0%。Karnofsky评分大于70分及小于50分,两组有显著性差异(P<0.05)。结论:采用温热疗法加局部化疗治疗恶性胸腔积液疗效确切、不良反应小、安全性高,值得继续关注。     

Non-metastatic Ewing's sarcoma of the ribs: the French Society of Pediatric Oncology Experience

From 1984 to 1997, 57 consecutive patients with non-metastatic Ewing's sarcoma of the ribs were treated according to multimodal French Society of Pediatric Oncology (SFOP) protocols EW 84, EW 88 and EW 93. The results of treatment were reviewed and analysed. Median age was 12 years. 34 patients had large tumours (greatest tumour dimension > or = 8 cm); pleural effusion was noted in 26. A tumour-positive margin after surgery was noted in 15 patients. Histological response after chemotherapy was assessed in 34 patients. 34 patients received radiation therapy. With a median follow-up of 5 years, the projected overall and relapse-free survival rates were 69 and 62%, respectively. The major site of relapse was local. None of the following was significant in predicting relapse: tumour size, gender, age at diagnosis, existence of pleural effusion, level of rib tumour, rib component, type of local control, surgical margin (positive or negative). Response to chemotherapy was the sole significant prognostic factor (P=0.004). Patients with pleural effusion had a higher percentage of relapse if they were treated without local radiation therapy. Our study confirms the prognostic significance of response to initial chemotherapy. Radiation therapy may be withheld in selected cases, but seems necessary in patients with pleural effusion.     

榄香烯乳及顺铂治疗肺癌所致双胸腔积液的临床对比观察

为对比顺铂（ＤＤＰ）与榄香烯乳（Ｌｘ）在治疗肺癌所致恶性胸腔积液的效果。１９９５年１２月至１９９７年１２月收治肺癌所致恶性双侧胸腔积液１７例，左侧注入ＤＤＰ，右侧注入Ｌｘ。结果表明：有效率左侧胸腔５８％，右侧９４％（Ｐ＜０．０５）。右侧胸膜增厚明显高于左侧（Ｐ＜０．０５）。结论是Ｌｘ治疗肺癌所致恶性胸腔积液效果好于ＤＤＰ，胸膜增厚与疗效有关。     

Pleural involvement in stage IIIM0 non-small-cell bronchogenic carcinoma. A need to differentiate subtypes

Forty-one patients with two subtypes of stage IIIM0 non-small-cell lung cancer treated over a 7-year period were evaluated. The first group of 20 patients had ipsilateral parietal pleural involvement not contiguous with the primary tumor but no distant metastases. Fifteen had positive pleural fluid cytology, seven with positive pleural biopsy in addition; four had extensive pleural studding or a positive biopsy but no effusion; and one had negative pleural fluid cytology. Treatment consisted of radiation therapy followed by combination chemotherapy in all. Due to symptoms, eight patients first had fluid drainage with or without sclerosis and two patients had a pleurectomy. Nine had progressive pleural disease despite the local treatment. To all modalities of therapy, only two patients had a partial response. One patient who had a pleurectomy lived 25 months. Median survival was 6.9 months. Cause of failure involved local progression in 17 patients. There was no difference in median survival by age, sex, histology, side of effusion, location of nodal disease, or use of local therapy. The second group of 21 patients had localized involvement of the parietal pleura by the primary tumor. There was deeper chest wall invasion in nine. All patients were rendered free of known disease by surgical resection, were stage T3N0-2M0, and received radiation and chemotherapy in addition to resection. The median survival was 13.5 months. There was local recurrence in nine patients but only one developed an effusion. Five patients were alive at 29-82 months. No variable unfavorably influenced survival except a central versus peripheral primary. Thus, the median survival of the patients in the first group with multiple sites of pleural involvement was similar to that of patients with distant metastases but with the cause of failure primarily local progression. In the majority of patients in the second group, parietal pleural and chest wall involvement, even with nodal metastases, did not translate into local failure, and long-term survival was possible.     

高聚生联用顺铂治疗恶性胸水的临床观察

目的：观察生物反应调节剂高聚生加顺铂治疗恶性胸水的疗效。方法：50例恶性胸水患者，25例行高聚生加顺铂治疗，另25例行白介素-Ⅱ加顺铂治疗作为对照组。结果：治疗组有效率与对照组接近，但Kamofsky评分高于对照组，不良反应少于对照组。结论：高聚生治疗胸水疗效确切，在改善生存质量方面优于白介素-Ⅱ，且不良反应少，可作为生物反应调节剂胸腔灌注治疗的首选。     

An assessment of the long-term results of controlling the reaccumulation of malignant effusions using intracavity bleomycin

Fifty-four consecutive patients with malignant effusions either pleural or peritoneal were treated by a simple aspiration followed by the administration of bleomycin to prevent a recurrence. All patients were followed up until reaccumulation of the effusion or death, with assessments being made of the patient's response at 30 days, 60 days, 90 days, 6 months, 1 year and then annually. There were 42 evaluable patients at 30 days, when the overall response rate for pleural effusions was 80.5% (21/26) and 62.5% (10/16) for peritoneal effusions. Patients who developed an effusion from primary breast neoplasms responded better than other groups, with an overall rate of 81% and 80% for pleural and peritoneal effusions respectively. Thirty percent (13) of the patients whose effusions was controlled by bleomycin required a further aspiration due to a recurrent effusions 9% (4) within the first 90 days and the remainder 21% (9) between 3 and 45 months after initial treatment. Altogether 19% (8/42) of the evaluable patients were effusion free at 1 year and 12% (5/42) clear at 3 years, but only two patients were still alive at four years. Side effects were minimal as 92% (50/54) patients treated experienced no adverse effects and there was no evidence of myelosuppression. The dose of bleomycin instilled varied between 60 mg and 180 mg, with 60 mg being given to 58% of patients and 90 mg to 30%, but there was no evidence to suggest that doses higher than 60 mg were more effective. The author concludes that the instillation of bleomycin following the simple aspiration of a malignant effusion is a safe, effective treatment which can benefit patients with this distressing complication of their malignant disease.     

诱导化疗与放化疗联合治疗合并同侧胸腔积液局限期小细胞肺癌的对比研究

Objective: The aim of the study was to explore the effects and side effects of induction chemotherapy followed by chemoradiotherapy for limited-disease small cell lung cancer (LD-SCLC) patients with ipsilateral pleural effusion.Methods: From January 2005 to May 2009, 52 LD-SCLC patients with ipsilateral pleural effusion were treated with induction chemotherapy got disappearance of pleural effusion after chemotherapy were underwent thoracic radiotherapy (TRT; 50 Gy/25 fraction) or same chemotherapy regimen; patients without disappearance or with increasing of pleural effusion after chemotherapy were given same chemotherapy regimen.Therapeutic effect was evaluated every two cycles according to RECIST 1.0 and side-effects were evaluated every cycle according to NCI-CTC AE Grades.All patients were followed up, and the median follow-up time was 26 months.Results: The response rate of patients was 80.7% (42/52) after induction chemotherapy and 34 patients got disappearance of pleural effusion.The median survival time, 1- and 2-year survival rates were 15.4 months, 76.9% (40 /52) and 38.5% (20 /52) respectively.The median survival time, 1- and 2-year survival rates of patients with pleural effusion remission received chest radiotherapy (A group, n = 20), patients with pleural effusion remission received chemotherapy (B group, n = 14) and patients without pleural effusion remission received chemotherapy (C group, n = 18) were 21.5 months, including myelosuppression, fatigue, nausea and vomiting.No therapeutic related death was occurred.Conclusion: Induction chemotherapy plus chemoradiotherapy has shown better effect in prolonging survival of small cell lung cancer (SCLC) patients with ipsilateral pleural effusion than chemotherapy alone.The patients with decreased ipsilateral pleural effusion may receive benefit from subsequent TRT.     

Sequential instillation therapy with mitomycin C and Adriamycin for superficial bladder cancer

Intravesical chemotherapy involving the sequential instillation of mitomycin C (MMC) and Adriamycin (ADM) was performed in 40 patients with superficial bladder cancer (pathological stages Ta and T1). In all, 20 mg MMC on day 1 and 30 mg ADM on day 2 were instilled into the bladder. This treatment was repeated weekly for 6 consecutive weeks and then monthly for 22 months in cases patients who did not experience serious side effects. A total of 20 patients were treated for multiple recurrences, and the efficacy was evaluated. In all, 9 subjects (45%) achieved a complete response and 6 (30%) showed a partial response, for an overall response rate of 75%. The other 20 patients, including 9 with primary multiple or high-grade tumors and 11 with recurrent tumors, received prophylactic instillation therapy after undergoing transurethral resection (TUR) of their lesions. Of the 9 primary cases, 3 recurred at 19, 8, and 3 months after TUR, respectively, whereas 6 showed no recurrence over a mean follow-up period of 14 months. Of the 11 recurrent cases, the 100-patient-month recurrence rate of 11.9 obtained prior to this treatment fell to 1.4 after the start of therapy. Chemical cystitis was observed in 20 of the 40 patients treated, but the symptoms were transient and tolerable.Presented at the 4th International Conference on Treatment of Urinary Tract Tumors with Adriamycin/Farmorubicin, 16–17 November 1990, Osaka, Japan     

乳腺癌恶性胸腔积液的临床特征及预后因素分析

目的研究有症状乳腺癌恶性胸腔积液患者的临床特征及影响疗效的相关因素。方法回顾性总结分析了2008年11月至2010年12月我科收治的36例有症状胸腔积液乳腺癌患者的一般临床资料[年龄、东部肿瘤协作组(ECOG)、手术病理分期、手术后无病生存期(DFS)、胸腔积液是否为初次复发部位、是否复发后一线化疗、是否伴有其他积液、是否双侧胸腔积液],胸腔积液的情况[是否血性胸腔积液、胸水细胞数、胸水单核细胞数、乳酸脱氢酶(LDH)、癌胚抗原(CEA)、CA153、CA125、蛋白、胸水量]及胸腔积液的治疗情况(胸腔局部治疗方式、胸腔局部化疗药物、是否使用IL-2)中各种因素对于胸腔积液疗效及控制时间的影响。结果患者手术至出现胸腔积液的中位时间44月(0～180月)。手术至出现胸腔积液的时间>44月有效率显著高于手术后DFS≤44月者(P=0.046),分别为66.7%,33.3%;复发后一线化疗者有效率显著高于复发后二线及以上化疗者(P=0.044),分别为65.0%和31.3%;胸水单核细胞数>1×106/L的患者有效率显著高于胸水单核细胞数≤1×106/L(P=0.046)的患者,分别为66.7%,33.3%。胸腔积液中位控制时间为4月,胸腔积液LDH≤400 u/ml较LDH>400 u/ml的患者的胸腔积液控制时间显著延长(P=0.032),胸腔积液中位控制时间分别为6月和2月。结论胸腔积液是乳腺癌患者常见的临床表现,术后DFS时间长、复发后一线化疗及胸水单核细胞高者有效率高,胸腔积液LDH浓度高是胸水控制时间短的不良预后因素。     

顺铂联合足叶乙甙治疗恶性胸腔积液60例

［目的］观察顺铂联合足叶乙甙联合治疗恶性胸腔积液的治疗效果。［方法］先将胸水尽量抽尽,将顺铂５０ｍｇ,足叶乙甙１００ｍｇ溶于生理盐水５０ｍｌ,胸腔内缓慢注射。［结果］６０例病人中,ＣＲ４４例,ＰＲ９例,总有效率８８．３％。［结论］顺铂联合足叶已甙胸腔化疗治疗恶性胸腔积液有效率高,毒副反应轻,是值得推广的疗法。     

热疗联合腔内灌注化疗治疗恶性胸腔积液的疗效观察

目的:观察热疗加局部药物注射治疗恶性胸腔积液的疗效、生活质量和不良反应。方法:确诊为恶性胸腔积液的患者50例,随机分为两组,采用中心静脉导管胸腔闭式引流尽可能排尽胸水后,A组给予胸腔灌注DDP化疗,然后进行患侧的胸腔深部热疗;B组只给胸腔灌注DDP化疗。结果:A组控制胸水的总有效率为83.3%,B组为61.5%■P<0.05■,A组与B组生活质量好转率分别为70.8%和46.1%(P<0.05)。结论:采用热疗加局部药物注射治疗恶性胸腔积液疗效确切,不良反应小,安全性高。     

EGFR mutations predict a favorable outcome for malignant pleural effusion of lung adenocarcinoma with Tarceva therapy

The aim of the present study was to evaluate the therapeutic effects and adverse reactions of Tarceva treatment for malignant pleural effusion (MPE) caused by metastatic lung adenocarcinomas. One hundred and twenty-eight patients who failed first-line chemotherapy drug treatment were divided into a mutation and a non-mutation group according to the presence or absence of epidermal growth factor receptor (EGFR) mutations. Each patient received closed drainage combined with simple negative pressure suction after thoracoscopic talc poudrage pleurodesis and oral Tarceva treatment. Short-term and long-term clinical therapeutic effects of Tarceva were evaluated. The EGFR mutation rate in pleural metastatic tissues of lung adenocarcinoma acquired through video-assisted thoracoscopic surgery was higher compared to that in surgical resection specimens, plasma specimens and pleural effusion specimens compared to previously reported results. There were significant statistical differences in the average extubation time (p<0.01), drainage volume of pleural effusion (p<0.05), Karnofsky score and formation of encapsulated pleural effusion 4 weeks after surgery (p<0.05) between these two groups. The number of patients with mild pleural hypertrophy in the mutation group was significantly higher compared to the non-mutation group (p<0.01), while the number of patients with severe pleural hypertrophy was significantly reduced (p<0.05). There was significant statistical discrepancy between these two groups in terms of improvement of peripheral blood carcinoembryonic antigen and tissue polypeptide antigen after 4 weeks of therapy. The complete remission rate and the efficacy rate were higher in the mutation group compared to that in the non-mutation group (p<0.05). There was a longer overall survival time after Tarceva treatment in patients with EGFR mutations than those without EGFR mutation. EGFR mutations predict a favorable outcome for malignant pleural effusion of lung adenocarcinoma with Tarceva therapy. Detection of EGFR mutations may determine the responsiveness of malignant pleural effusion to Tarceva treatment.     

局麻下电视胸腔镜手术诊治恶性胸腔积液的探讨

目的：探讨局麻下电视胸腔镜手术（video-thoracoscopic surgery,VTS)诊治恶性胸腔积液的安全性和效果。方法：自2000年1月到2001年1月,探索性地在局麻下对8例恶性胸腔积液患者和7例疑患恶性胸腔积液者实施了VTS。其中3例为无法耐受全麻的高危患者。结果：对8例恶性胸腔积液患者分别进行了VTS－肺纤维膜剥脱、滑石粉洒胸膜固定术（2例）和VTS－滑石粉喷洒胸膜固定术（6例）。对7例疑患恶性胸腔积液者首先进行了VTS－胸膜腔探查,发现积液由胸膜病变引起者5例,胸膜活检均诊为转移腺癌,随后进行了VTS－滑石粉喷洒胸膜固定术;另2例脏壁层胸膜均正常,证实积液为纵隔淋巴结广泛肿大造成胸膜淋巴液引流障碍所致。以上操作在局麻下顺利完成。手术时间30－120min。期间病人的心率、血压及血氧饱和度均无明显变化。术后无严重并发症和死亡。术后住院时间7－10天。随访1－8个月,平均5个月,胸腔积液均得到控制,未见复发。与控制积液有关的花费平均为3000元。结论：局麻下进行VTS诊治恶性胸腔积液是安全、有效的。该方法经济、创伤少,值得推广应用。     

10-羟基喜树碱腔内注射治疗恶性胸腹水

目的观察１０－羟基喜树碱腔内注射治疗恶性胸（腹）水的疗效。方法腔内灌注１０－羟基喜树碱治疗２７例恶性胸（腹）腔积液患者。结果ＣＲ９例,ＰＲ１３例,ＮＲ５例。有效率８１．５％（２２／２７）。此局部治疗耐受性好,无明显毒副反应。结论与其它胸（腹）水治疗方法比较,该方法具有疗效高、毒副反应低的特点。