亚砷酸胸腔注射治疗恶性胸腔积液

目的:评价亚砷酸胸腔注射治疗恶性胸腔积液的临床价值。方法:恶性胸腔积液患者68例,均经细胞学和病理学确诊,随机分为治疗组和对照组:在胸膜腔积液充分引流后,治疗组36例,胸膜腔内注射亚砷酸10mg~20mg,每天或隔日1次,连续3次;对照组32例,胸膜腔内注射博莱霉素30mg/m2,7天1次,共1~2次。观察疗效、毒副反应、生活质量。结果:治疗组CR10例(28%),PR16例(44%),总有效率为26/36(72%);对照组CR8例(36%),PR13例(45%),总有效率为21/32(65%),两组有效率差异无显著性(P>0.05)。治疗组注药后胸痛反应明显低于对照组(P<0.05),胃肠道反应、骨髓抑制、发热反应两组间无明显差异(P>0.05)。治疗后两组KPS评分均有增加,治疗前后比较有明显差异(P<0.05)。结论:亚砷酸胸腔注射治疗恶性胸腔积液是一种有效、安全的方法。

Treatment of malignant pleural effusion by injecting arsenic trioxide into pleural cavity

Objective:To evaluate the clinical value of arsenic trioxide in treating malignant pleural effusion by injecting into pleural cavity. Methods: Sixty-eight patients, required to have a cytologically positive pleural effusion or a positive pleural biopsy in the presence of an exudative effusion, were randomly divided into two groups. After the accumulation of pleural fluid had been adequately drained, 36 patients were randomized to Arsenic trioxide group, receiving arsenic trioxide 10mg~20mg, once a day or once two days, on 3 successive times; 32 patients were randomized to Bleomycin group receiving bleomycin 30mg/m~2, once a week, for 1~2 times, which were administered via chest tube or directly injected into pleural cavity. Then the efficacy, toxicity and performance status were evaluated. Results: In the Arsenic trioxide group, ten patients (28%) achieved CR and 16 patients (44%) PR; the overall response rate was 26/36 (72%). In the Bleomycin group eight patients (25%) achieved CR, 13(40%) PR; the overall response rate was 25/32 (65 %). No statistically significant difference in response rate was present between the two groups (P>0.05).The incidence rates of side effect including myelosuppession, nausea and vomiting had no statistically significant difference between the two groups(P>0.05). But the incidence rate of chest pain was more lower in arsenic trioxide group than in bleomycin group (P<0.05). After treatment the Karnofsky score were increased in both groups (P<0.05). Conclusion: The treatment of malignant pleural effusion with arsenic trioxide is an effective, safe method with little side effects.