Details

        Clinical observation analysis of continuous thermostatic circulatory hyperthermic perfusion chemotherapy to treat 84 patients with malignant pleural effusion

        Date:2014年2月26日 16:28

        Xin Guan, Hongmei Sun, Bing Liu, Bin Wang, Limin Liu, Guangyuan Zhu, Henian Sun
        (Heilongjiang Province Jiamusi City Tumor Hospital, Jiamusi City 154007, Heilongjiang Province)

        Abstract : Objective: To investigate efficacy of continuous thermostatic (42 ~ 43℃)  circulatory hyperthermic perfusion chemotherapy to treat malignant pleural effusion. Methods: 84 patients with malignant pleural effusion were randomly divided into two groups. Observation group included 44 cases, and conventional puncture needles were used to establish circulatory dual passages. At first, the pleural cavity was rinsed, perfusion liquid in the pleural cavity was replaced, at last, 1500 ~ 2000ml liquid was kept in the pleural cavity to maintain constant temperature (42-43℃). 3-5min after the beginning of the circulation, cisplatin 60mg was added in the pipeline, and continuous thermostatic circulatory hyperthermic perfusion chemotherapy lasted for 60minutes. After the end of the treatment, therapeutic liquid was released and the remaining 1000-1500ml was kept in the pleural cavity. Control group included 40 cases and the drainage catheter in the pleural cavity was replaced. At first, the pleural cavity was rinsed and then, 1000-1500ml liquid with cisplatin 60mg was perfused. All drug liquid in control group had been heated to 43℃ before it was perfused into pleural cavity. Results: The total effective rate of observation group was 90.2% and was significantly higher than control group. Conclusion: Compared with conventional catheterization and extraction, continuous thermostatic circulatory hyperthermic thoracic perfusion chemotherapy significantly improves the effective rate of treating malignant pleural effusion, and meanwhile significantly improves resurgence of malignant effusion and improves the quality of life in cancer patients in advanced stage.
        Keywords: malignant pleural effusion, continuous thermostatic circulatory hyperthermic perfusion chemotherapy

        1Materials and Methods
        1.1General Information: 84 hospitalized patients were selected and were randomly divided into continuous thermostatic circulatory chemotherapy group (observation group) including 44 cases and pleural cavity simple extraction plus chemotherapy group (control group) including 40 cases. Inclusion criteria: They should be 40 to 70 years; KS score > 50 points; all patients were confirmed by ultrasound to have more than moderate pleural effusion; cancerous pleural effusion had not received any treatment and no drug had been injected into the pleural cavity; liver, kidney function and blood routine test were in the normal range; expected survival period was more than 3 months. Observation group had 44 cases, aged 41 to 70 years, including 30 cases of lung cancer, 8 of breast cancer, 4 of lymphoma and 2 of primary pleural tumor; control group had 40 cases, aged 40 to 69 years, including 30 cases of lung cancer, 6 of breast cancer, 2 of lymphoma and 2 of primary pleural tumor.
        1.2 Methods
        1.2.1 Observation group: Before the treatment, each patient in observation group underwent B ultrasound positioning to determine the puncture point. The inflow and outflow dual needles were punctured. According to patients’ sticky pleural fluid or not sticky one, one-way hyperthermic perfusion was performed or not. Warm physiological saline 1000-1500ml was perfused and the liquid was released during perfusion. Partial malignant effusion was discharged and the pleural cavity was rinsed. After the end of the perfusion, a TRL2000 cardiopulmonary bypass hyperthermic perfusion machine was connected and the temperature was set at 45℃. The inflow temperature was set at 43-43.5℃ and the outflow temperature was set at 40-41℃. Chemotherapeutic drug cisplatin 60mg was added and continuous thermostatic circulation lasted for 60min. After the end of the circulation, partial liquid was discharged and amount of the remaining liquid was > 1000ml. The above treatment was performed once every 72 hours for 3 consecutive times.
        1.2.2 Control group: Each patient in control group underwent conventional pleural puncture, and the central venous catheter was indwelled in the pleural cavity. Continuous drainage began. The pleural effusion was drained out as much as possible and was rinsed. Then, perfusion liquid with cisplatin 60mg, which had been heated to 43℃, was perfused once every 72h for consecutive 3 times.
        No patients in the two groups received systemic chemotherapy during treatment. Amount of the pleural effusion measured by B ultrasound before and after treatment was used as observation index, and KS score was also observed.
        1.3 Efficacy evaluation: Efficacy was evaluated according to WHO criteria. Complete remission (CR): Pleural effusion disappeared and the state had lasted for more than 4 weeks; Partial remission (PR): Pleural effusion reduced by more than 1/2 and the state had lasted for more than 4 weeks, and symptoms were relieved; No effect (NC): Pleural effusion reduced less than 1/2 and symptoms were not improved. Effectiveness: CR + PR.
         
        2 Results
        2.1 Clinical efficacy: All of the patients completed treatments for more than 3 times. The effective rate of observation group was 90.2% and the complete remission rate was 32.1%; the effective rate of control group was 57.4% and the complete remission rate was 15.4%.
        2.2 Toxic and side reactions: The patients of the two groups had mild side reactions such as nausea, vomiting, fatigue, poor appetite and leucopenia. Chest pain of observation group was lighter than control group, and recovered soon after symptomatic treatment.

        3Discussion
        There are various therapeutic methods to treat malignant pleural effusion, and hyperthermic thoracic perfusion chemotherapy has been increasingly emphasized and has been affirmed by more clinicians. Its mechanism of action is: tumor tissue is more sensitive to heat than normal tissue, thus heating directly kills cancer cells. At more than 42℃ for 60minutes, significant inactivation effect on malignant cells can be achieved. Hyperthermia increases local drug concentration in tumor tissue and high concentrations of chemotherapeutic drugs can overcome tumor cell tolerance to better exert anticancer effect. Heating can increase sensitivity of tumor cells to chemotherapeutic drugs, and meanwhile enhance cell permeability and strengthen efficacy of anticancer drugs. The effective rate of continuous thermostatic circulative hyperthermic perfusion chemotherapy group was 90.2%, and was significantly higher than simply hyperthermic thoracic chemotherapy group, whereas their toxic and side effects were similar.
        In summary, when circulatory hyperthermic perfusion chemotherapy is used to treat malignant pleural effusion, it can effectively control growth of pleural effusion, alleviate the suffering of patients, and can effectively prolong the survival time and improve the quality of life of patients to achieve satisfactory clinical effect. Therefore, it is worth clinical popularization.

        References:
        1. Yan Sun. Manual of clinical oncological internal medicine. The 2nd edition. Beijing: People's Medical Publishing House, 1991.23.
        2. Jichang Zhou. Practical oncological internal medicine. Beijing: People's Medical Publishing House, 1998, 131-142.
        3. Gangqing Zhang. Continuous hyperthermic intraperitoneal perfusion chemotherapy. Foreign Medicine: Volume Oncology, 1997, 24(1): 49-51.
        4. Hua Zhou, Wenli Deng. Clinical observation of hyperthermic perfusion combining with chemotherapy to treat 21 patients with malignant pleural effusion [J].Modern Medicine and Health Care, 2005, 21 (18): 2477-2478 .

        Editing/Qian Yang

        Received Date: March 21, 2011

        Medical Information, May, 2011, 24(5): 2817-2818.

        1994-2012 China Academic Journal Electronic Publishing House. All rights reserved.
        http://www.cnki.net

        TypeInfo: academic articles

        Keywords for the information: