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 .

Comparison of the therapeutic effects of pleural perfusion of NDP and cDDP in NSCLC patients with malignant pleural effusion

Objective To compare the therapeutic effects of pleural perfusion of NDP and cDDP in non-small cell lung cancer ( NSCLC) patients with malignant pleural effusion, their quality of life and toxic side effects. Methods Sixty-eight NSCLC patients with malignant pleural effusion after chest drainage were randomly divided into two groups according to the pathological types: 34 cases in the NDP (Group A) and cDDP groups (Group B) , 34 cases each.They were treated with NDP (40 mg/m2) and dexamethasone (10 mg) dissolved in 40 ml normal saline, or cDDP (40 mg/m2) and dexamethasone (10 mg ) dissolved in 40 ml of normal saline, respectively, through pleural perfusion weekly for 2-4 weeks. Routine and symptomatic treatment was used in all the patients.The therapeutic effects, life quality and toxic side effects were evaluated. Results The response rates of groups A and B were 88.23% and 61.7% , respectively, ( P < 0.01). The rates of toxic side effects in groups A and B were 39.6% and 41.9% , respectively, (P > 0.05 ). However, the rates of gastrointestinal side effects of the two groups were 5% and 12. 9% , respectively, ( P < 0.05).The Karnofsky scores of group A were higher than that in group B (P < 0. 05). The survival time of group A was significantly longer than that of group B. Conclusion Pleural perfusion with NDP is a good treatment method with milder toxicity for patients with malignant pleural effusion caused by NSCLC.