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        The efficacy contrast observation of CCCHP and CHP in treatment of malignant effusion

        Date:2014年2月26日 16:27

        Department of Oncology, Jiangxi Province Xingan County People's Hospital, Xingan County 331300, Jiangxi Province

        [Abstract] Objective The therapeutic efficacy of using CCCHP and CHP to treat malignant effusion is compared in this essay.  Methods The author observed the efficacy and toxic reaction of using CCCHP and CHP to treat the 130 cases of malignant  effusions  and analyzed  the liquid ’s  differences  in temperature  when using  the  two  methods  to  go through  the body cavity at different times. Results The RR rate of the CCCHP group (86%) was noticeably higher than that of the CHP group(57.5%). The CR rate of the CCCHP group(31.6%)was noticeably higher than that of the CHP group(17.8%).The differences were statistically significant. There were differences in temperature of going out of the body cavity and the longer the time period was ,the  more noticeable  difference can be got. Conclusion CCCHP can ensure the temperature of the effective treatment within the cavity, and the therapeutic efficacy of treating malignant effusions is noticeably improved.

        [Key words] CCCHP; CHP; malignant effusion; comparison of efficacy
        [CLC] R734 [Document ID code] B [Article number] 1673-9701 (2012) 35-0151-02

        Malignant coelom effusion is a common complication in most of tumor patients in moderate and advanced stages. From January 2009, department of oncology in our hospital has begun to perform continuous thermostatic circulatory coelom hyperthermic perfusion chemotherapy (CCCHP) to treat malignant pleural effusion and ascites, and we analyze and compare mechanism, feasibility, efficacy and toxic and side reactions between the therapeutic method and previously used coelom hyperthermic perfusion chemotherapy (CHP) through clinical observation. Now report as follows.

        1 Subjects and methods
        1.1 The subjects of the study
        57 patients from January 2009 to June 2012 received CCCHP treatment and 73 patients from June 2005 to January 2009 received CHP treatment, and the two treatments were compared. The 130 cases of malignant effusion included 89 cases of ascites and 41 cases of pleural effusion, aged 38 to 70 years old; physical scoring criteria (ECOG) NCI [1] was 0-3; all patients were definitely diagnosed as malignant pleural effusion or ascites by pathology and B ultrasound, and their liver, kidney function and blood routine test were in the normal range; age, diseases, etc. between the two groups of patients were comparable.
        1.2 Instrumentation
        TRL 2000 extracorporeal circulatory hyperthermic perfusion chemotherapy machine (Harbin Aerospace Science and Technology Co., Ltd.)

        1.3 Methods
        In CCCHP group, conventional puncture needles were used to established circulatory dual passages. At first, the coelom was rinsed and the perfusion liquid in the thoracic or abdominal cavity was replaced, and at last 500-1000 m1 liquid was maintained in the thoracic cavity and 2500-3500 m1 liquid was maintained in the abdominal cavity. The inflow temperature was regulated to 43.5-44.5℃, and the outflow temperature in the abdominal cavity was usually at 39.5-40.5 ℃ and that in the thoracic cavity was at 41-42℃. 3-5 min after the beginning of circulation, DDP 40 mg was added in the pipeline. Thermostatic circulatory hyperthermic chemotherapy lasted for 60 minutes. After the end of the treatment, therapeutic liquid was released, and less than 1500ml liquid was maintain in the abdominal cavity and 500ml liquid was maintained in the thoracic cavity. The above treatment was performed once every 72 hours for 3 consecutive times. In CHP group, routine coelom puncture was performed and the single-cavity deep venous catheter was indwelled and continuous drainage was performed. The effusion was drained as much as possible and was rinsed. Then, perfusion liquid, which had been heated to 45℃, was perfused to perform coelom hyperthermic chemotherapy. The treatment was performed once every 72 hours for 3 consecutive times. During treatment, no patients in the two groups received systemic chemotherapy and interferon, interleukin-2 and other immunotherapy, and the patients only received symptomatic treatment.

        1.4 Evaluation of efficacy
        Efficacy was evaluated according to WPS criteria. Complete remission (CR): Symptoms disappeared and effusion was completely absorbed, and the state lasted for 4 weeks. Partial remission (PR): Symptoms were improved and effusion reduced by more than 1/2, and the state lasted for 4 weeks. Stable disease (SD): Effusion reduced by less than 1/2 or increased by less than 1/4, and the state lasted for 4 weeks. No response (NR): Effusion increased by more than 1/4. After receiving perfusion of liquid at 45℃, 20 cases in each group were observed and recorded, and their fever, chest pain, liver and kidney impairment and other toxic and side effects were measured.

        1.5 Statistical analysis
        Based on SPSS 13.0 statistical software, χ2 test was used to compare count data, analysis of variance and t test were used to compare measurement data, and P <0.05 was considered statistically significant.

        Table 1   Comparison of clinical efficacies between CCCHP and CHP [n (%)]

        Group

        n

        CR

        PR

        SD

        NR

        CR+PR

        χ2 Value

        P Value

        CCCHP
        group

        57

        18(31.6)

        31(54.4)

        5(8.8)

        3(5.3)

        49(86.0)

        12.32

        0.0448

        CHP
        group

        73

        13(17.8)

        29(39.7)

        22(30.1)

        9(12.3)

        42(57.5)

         

        2 Results
        2.1 efficacy and toxic and side effects
        Adverse reactions were mainly abdominal distension, abdominal pain, chest pain and vomiting, and were all tolerable. After the ice pillow was routinely used on the head, no brain was harmed by hyperthermia. Complications included 3 cases of intestinal perforation, 1 case of pneumothorax and 1 case of chemical peritonitis. When effusion was less, B ultrasound positioning could reduce the incidence of complications. After treatment, no liver and kidney impairment was found. See Table 1.
        2.2 Contrast analysis of the temperatures of liquid flowing in and out of coelom in CCCHP and CHP groups
        After 45 ℃ liquid was perfused into each body of 20 cases in each group, outflow temperatures at 15, 30, 60 minutes were compared between groups. The differences were statistically significant (P <0.05). The outflow temperatures in CCCHP group at the 3 time points were higher than CHP group (Table 2).

        Table 2 Comparison of the temperatures of liquid flowing in and out of coelom at different time points with two methods (  ± s, ℃)

        Group

        n

        15min Tout 

        30 min Tout

        60 min Tout

        F value

        CCCHP group
        CHP group
        t value
        P

        20
        20

         

        40.035±0.916
        39.255±0.528
        2.903
        <0.05

        40.15±1.631
        38.8±1.144
        3.611
        <0.05

        39.735±1.916
        37.995±1.299
        4.339
        <0.05

        1.218
        1.031

         

        Tout = the temperature of liquid flowing out of coelom

        3Discussion
        Coelom hyperthermic perfusion chemotherapy makes use of thermal effect and synergic effect of local chemotherapy. Mechanisms are mainly: (1) Heat directly kills cancer cells. (2)
        Permeability and cytotoxicity of chemotherapeutic drugs are strengthened. (3) Heat shock protein is produced to induce specific immunity. (4) Cancer cells are rinsed out of the body [2]. These mechanisms form the theoretical basis of coelom hyperthermic perfusion chemotherapy.
        Because the main antitumor mechanism of hyperthermic perfusion chemotherapy is hyperthermic direct killing effect on tumor, the effective therapeutic temperature in the abdominal cavity is critical to obtain satisfactory clinical efficacy [3] .However, most of CHP energy sources are the heater thermostat or preheated perfusion liquid, and pleural or peritoneal serosal area is large and has strong absorption of heat dissipation, therefore, perfusion liquid without continuous heating cannot keep temperature at which apoptosis/necrosis of cancer cells occurs [4]. The observation has found that the outflow temperatures at 15, 30, 60 minutes in CHP group were lower than CCCHP group, and CHP group was difficult to maintain therapeutic temperature of 42-43℃ in the body.
        CCCHP establishes circulation by the closed circulatory pipeline to achieve continuous thermostatic circulatory hyperthermic therapy. A lot of warm physiological saline is used to rinse and replace the original coelom effusion to change the quality of the effusion but not to change the volume, thus adverse reactions caused by releasing too much liquid at a time can be prevented. Then, circulatory perfusion of liquid can better clean the coelom, change the traditional method that stimulation of drugs are used to generate adhesions for reducing pleural effusion, and eliminate the intestinal adhesion, chemical peritonitis and other complications caused by high local drug concentration.
        Clinical observation found that the effective rate of CCCHP group was 86% and was statistically significantly higher than the effective rate 57.5% of CHP group (P <0.05). CCCHP has good drug diffusion and less residual dead space, and through the long killing of hyperthermic drugs, perfusion and rinsing, effusion replacement, drainage and other actions, the treatment can achieve fast cytoreductive effect in a short time. Many patients with pleural effusion or ascites cannot be controlled with CHP treatment for 6 to 12 times, whereas most of them can be significantly relieved with CCCHP for 2 to 3 times. Therefore, CCCHP improves efficacy and reduces the burden on patients.

        References
        [1]Jichang Zhou. Practical oncological internal medicine[M]. Beijing: People's Health Publishing House, 2003:48.
        [2]Ke’ai Li, Zhongfang Hao. Clinical observation of coelom hyperthermic perfusion chemotherapy for malignant pleural effusion (ascites) [J] Tianjin Medicine, 2012, 40 (2): 195.
        [3] Di Giogio A, Naticchioni E, Biacchi D, et al. Cytoreductive surgery (peritonctomy procedures) combined with HIPEC in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer [J] Cancer, 2008,113 (2): 315.
        [4]Yanguang Zhu, Wenchao Liu. Clinical application of thermostatic circulatory hyperthermic perfusion chemotherapy in the prevention and treatment of coelom metastatic cancers [J] Modern Oncology, 2009, 17 (6): 1166.

        (Received Date: September 3, 2012)

        Clinical Study

        China Modern Doctor, December, 2012, 50(35): 151-152

        TypeInfo: academic articles

        Keywords for the information: