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Objective:To study the effect of Zhushui plaster application and nursing combined with elemene injection on the psychological state, the degree of cancer-related fatigue, and the quality of life of lung cancer patients with malignant pleural effusion.Methods:According to the clinical controlled trial, a total of 100 patients with malignant pleural effusion of lung cancer admitted to the Department of Cardiothoracic Surgery Ⅱ and Vascular Surgery of Ningbo Medical Center Lihuili Hospital from April 2019 to December 2021 were convenient selected and divided into control group and experimental group with 50 cases in each group by random number table method. The control group received intrapleural perfusion therapy with elemene injection, and the experimental group was treated with Zhushui plaster on the basis of the control group. The psychological state, cancer-induced fatigue and quality of life of the two groups before and after treatment were compared.Results:There was no significant difference in baseline data between the two groups before intervention (all P>0.05). There were no significant differences in psychological status, cancer-induced fatigue and the quality of life before intervention between the two groups (all P>0.05). After the intervention, the anxious and depressed scores of the patients in the experimental group were (64.12 ± 3.24) and (60.38 ± 3.00), respectively, which were lower than those in the control group, (66.00 ± 3.69) and (62.10 ± 3.30), and the differences were statistically significant ( t=2.72, 2.73, both P<0.05). The scores of perceived fatigue, emotional fatigue, cognitive fatigue and behavioral fatigue in the experimental group were (5.66 ± 0.59), (5.26 ± 0.75), (4.00 ± 0.93) and (5.08 ± 0.80), respectively, which were lower than those in the control group, (5.98 ± 0.74), (5.70 ± 1.09), (4.42 ± 1.07) and (5.52 ± 1.00), respectively, and the differences were statistically significant ( t values were 2.10-2.46, all P<0.05); in addition, the dimensions and total scores of the quality of life in the experimental group were (50.54 ± 5.09), (52.49 ± 4.46), (50.40 ± 4.40), (48.96 ± 3.32) and (202.38 ± 15.42), respectively, which were higher than those in the control group, (47.82 ± 6.69), (49.40 ± 6.28), (47.24 ± 4.70), (46.56 ± 4.13) and (191.00 ± 15.79) respectively, and the differences were statistically significant ( t values were -3.65--2.29, all P<0.05). Conclusions:Zhushui plaster application and nursing combined with elemene injection can not only effectively control the negative psychological state of lung cancer patients with malignant pleural effusion and reduce the degree of cancer-related fatigue, but also improve their quality of life.
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Introduction: Pleural effusion is one of the manifestation of a malignant disease which may be malignant pleural effusion with demonstrable malignant cells in the fluid or para-malignant pleural effusion which is reactive response or due obstruction of lymphatic drainage rather than invasion of pleural cavity. Various modalities are there to investigate this condition including routine microscopy, cytology, biopsy etc. Objective: To understand and compare the utility of cancer ratio, tumor markers, malignant cytology in cases of suspected malignant pleural effusion. Material and Methods: This Case Control Cross sectional study was conducted among patients attending respiratory OPD at Sir Sunder Lal Hospital, BHU, Varanasi, diagnosed with malignant pleural effusion and non-malignant pleural effusion. Results: Significant association was found between Cancer Ratio-Carcinoembryonic Antigen, CEA (p = 0.0069), CEA-Cytology (p = <0.01801)
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Introduction: Thoracocentesis and pleural biopsy are recommended for the evaluation of undiagnosed exudative pleural effusion. There are multiple etiologies associated with them, out of which malignancy is one of them. Hence, the diagnosis of malignant pleural effusion (MPE) has been proposed in recent perspectives. We aimed to find the profile of MPE, efficacy of percutaneous closed needle pleural biopsy (PCNPB) in diagnosing MPE, overall yield, and complication rate to evaluate the continued relevance of this traditional procedure. Methods: This was a prospective study carried out on consecutive consenting patients at the Department of Pulmonary Medicine at a tertiary care hospital from July 2016 to May 2018. The diagnosis was based on cytobiochemical, microbiological, and histopathological results along with clinical history. Data were analyzed with respect to pleural fluid assessment in terms of cytobiochemical and microbiological evaluation; while pleural biopsy was studied histopathologically. Results: Two hundred and fifty patients with exudative pleural effusion were enrolled. Tuberculosis (218, 87.2%) was the most common etiology followed by malignancy (22, 8.8%). The most common presenting complaint was chest pain (100%) followed by dyspnea (90.47%). Metastatic adenocarcinoma was found in 81.81% followed by mesothelioma in 18.18%. The sensitivity of pleural biopsy for malignancy was found to be 63.63% (p < 0.003, odds ratio [OR]: 2.01), and those fulfilling Leung's criteria, sensitivity was found to be 90.90% (p < 0.001, OR: 3.67). The sensitivity of pleural fluid for malignancy was 18.18% (p < 0.05, OR: 1.51). All cases of mesothelioma have asbestos exposure. The complication in the form of mild post-pleural biopsy pain was encountered in 10%, which required mild analgesics. Other complications in the form of self-resolving pneumothorax were seen in 6%, which increased hospital stay to 2�days and self-resolving hematoma (3%). Conclusion: In this modern era, PCNPB still holds high sensitivity, efficacy rate, and relevance for diagnosing MPE with less complication rate, less hospital stay, and can be done on a daycare basis. Also, we have very less research and paperwork regarding this topic.
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Abstract Thyroid cancer is the most common endocrine cancer. It generally has a good prognosis, with a 10-year survival rate of over 90%. Pleural metastasis is uncommon. We present two cases of papillary thyroid cancer with pleural metastases. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2216).
Resumen El cáncer de tiroides es la neoplasia endocrinológica más común. Suele presentar un buen pro nóstico con una sobrevida a 10 años mayor al 90%. El compromiso metastásico pleural es poco frecuente. Presentamos dos casos de cáncer papilar de tiroides con compromiso pleural metastásico. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2216).
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Malignant pleural effusion (MPE) is one of the frequent and distressing conditions identified at the advanced stage of different malignant conditions. This problem seems to affect patients with lung and breast malignancies which contribute to the lower life quality. Less commonly MPE presents as a loculated fluid collection. We present an unusual case of cystic fluid collection in contact with the heart appearing similar to a pericardial cyst, but on cytological examination turned out to be loculated MPE. Furthermore, there was the presence of malignant fissural effusion. This text highlights the unusual location of this loculated MPE along with a few characteristic features to differentiate it from the benign pericardial cyst
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Resumen Revisión narrativa sobre cómo el cáncer altera la fisiología de la pleura, cómo se estudia el derrame pleural maligno y cómo se puede brindar paliación al paciente con derrame pleural mediante el catéter pleural permanente tunelizado, cuyo uso demuestra mayores beneficios en diferentes ámbitos clínicos, siendo utilizado principalmente para el tratamiento del derrame pleural tumoral recurrente, pero también en algunos casos de derrame pleural benigno repetitivo, convirtiéndolo en un recurso terapéutico útil en el cáncer avanzado.
Abstract This narrative review examines how cancer causes changes in pleural physiology, how to study malignant pleural effusion, and how to bring palliative care to patients with pleural effusion by means of indwelling tunneled pleural catheter. This catheter shows greater benefits in clinical practice, being used mainly for the treatment of recurrent malignant pleural effusion, but also in some cases of recurrent benign pleural effusion, making it a useful therapeutic tool in advanced cancer.
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Humans , Palliative Care , Pleural Effusion , Pleural Effusion, Malignant , Therapeutics , CathetersABSTRACT
Background:Malignant pleural effusion (MPE) is a common clinical condition observed in patients suffering from malignant diseases. None of the tumour markers have both high sensitivity and specificity. A retrospective study on patients with pleural effusion was done to evaluate the diagnostic accuracy of Cancer ratio (CR) in diagnosing MPE.Methods:A retrospective analysis of patients with undiagnosed exudative pleural effusion was done. Results of serum Lactate dehydrogenase (LDH), pleural fluid Adenosine deaminase (ADA), pleural fluid analysis such as cytology and histopathology reports of pleural biopsy were analyzed. Serum LDH: pleural fluid ADA ratio (CR) was calculated and compared with histopathology report. Data were analyzed statistically.Results:A total of 102 patients were enrolled in the study (56 males and 46 females). The sensitivity and specificity of CR at the cut off level of >20 were 57.14% and 75.47% respectively. The positive predictive value was 68.29% and the negative predictive value was 65.57%. CR>20 (p<0.001) is statistically significant in predicting malignancy in undiagnosed exudative pleural effusions. Conclusions:CR has a high sensitivity and specificity and is a novel tool in differentiating malignant from nonmalignant pleural effusions. Patients with unconfirmed diagnosis but higher CR will identify the need for early biopsy, follow-up and frequent or repeat chest imaging to assess the progression.
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Pleural effusion is a common clinical pleural disease, and it is also an accompanying manifestation of many diseases. The characteristics and etiological diagnosis of pleural effusion have always been the focus of clinical attention. Pleural effusion is divided into exudate and exudative effusion, and tuberculous pleural effusion and malignant pleural effusion are more common in exudative pleural effusion. Its characteristics and the selection of appropriate diagnostic methods are crucial to the treatment and prognosis of patients. With the rapid development of experimental technology and molecular biology, some new experimental techniques and experimental indicators have emerged. In this review, the characteristics of tuberculous pleural effusion and malignant pleural effusion and the research progress of its differential diagnosis methods were reviewed.
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Abstract Background: The use of Indwelling Pleural Catheter (IPC) in the care of patients with Malignant Pleural Effusion (MPE) is well established, however studies involving public health systems of low and middle-income countries are still lacking. This study aimed to determine the effect of IPC on the respiratory symptoms and Quality of Life (QoL) of patients with MPE in the setting of a Brazilian public health system. Methods: From August 2015 to November 2019, patients with MPE underwent IPC placement and were prospectively followed. QoL and respiratory symptoms were assessed by the EORTC questionnaires (QLQ-30; LC13) and Visual Analogue Scale (VAS), respectively, at pre-treatment, 30 , and 60 days after IPC placement. Results: 56 patients were enrolled with 57 catheters inserted. The mean age was 63 (23‒88) years, of which 17 (30%) were men and 39 (70%) were women. Breast 24 (42%) and lung 21 (37%) were the main primary neoplasms. Cellulitis was the most common complication and all patients recovered with appropriate antimicrobial therapy. QoL did not change significantly over time, however, the VAS showed a significant improvement in dyspnea (+1.2: -0.5; p = 0.001). Conclusion: IPC relieves respiratory symptoms without compromising the QoL, with a low complication rate. It represents a suitable option for patients with MPE and short LE in an emerging country. HIGHLIGHTS Indwelling pleural catheter represents a suitable option for patients with malignant pleural effusion and short life expectancy. It relieves respiratory symptoms without compromising the quality of life, and the complication rate is low, even in an emerging country, with a low socioeconomic and under-educated patient population. The rate of spontaneous pleurodesis was 45%. The analysis of the visual analog scale showed significant control of dyspnea (p = 0.001), but pain and quality of life did not change significantly.
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OBJECTIVES: We compared the diagnostic potential of cancer ratio (CR, serum lactate dehydrogenase [LDH]/pleural fluid adenosine deaminase [pfADA]), cancer ratio plus (CR plus, cancer ratio/pleural lymphocyte percentage), and age/pfADA ratio with pfADA in malignant pleural effusion. METHODS: Data from 100 patients with malignant pleural effusion (MPE) and 119 patients with tuberculous pleural effusion (TPE) were retrospectively collected. PfADA, age/pfADA ratio, CR, and CR plus were compared between patients with MPE and those with TPE in two age groups (≤50 and >50 years). The best cut-off value was determined, and the diagnostic performance was evaluated according to the receiver operating characteristic curve. RESULTS: PfADA was statistically significantly lower while age/pfADA ratio, CR, and CR plus were significantly higher in the MPE group than in the TPE group in both age groups (p<0.05). For patients aged ≤50 years, the differential diagnostic value of pfADA for MPE was better than those of age/pfADA ratio, CR, and CR plus. At a cut-off value of 13.0 U/L, the sensitivity, specificity, and accuracy were 88.9%, 100.0%, and 98.9%, respectively. For patients aged >50 years, the diagnostic performance of CR plus was superior to those of pfADA, age/pfADA ratio, and CR. At a cut-off value of 22.6, the sensitivity, specificity, and accuracy of CR plus for the diagnosis of MPE were 86.8%, 84.6%, and 86.2%, respectively. CONCLUSIONS: The best parameter for diagnosing MPE was different for patients aged ≤50 years and >50 years. For patients aged >50 years, CR plus was a good parameter for the differential diagnosis of MPE. For patients aged ≤50 years, pfADA was better.
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Humans , Child, Preschool , Middle Aged , Pleural Effusion/diagnosis , Pleural Effusion, Malignant/diagnosis , Adenosine Deaminase , Retrospective Studies , Sensitivity and Specificity , Diagnosis, DifferentialABSTRACT
Lung cancer is the malignancy with the highest mortality rate worldwide. Malignant pleural effusion (MPE) caused by advanced lung cancer severely affects the quality of life and prognosis of patients. Tumor-associated genetic testing is the basis for making precise treatment decisions. There are some risks of tissue biopsy, and it is difficult to sample repeatedly. Due to its non-invasive and can reflect the full profile of tumor gene characteristics, liquid biopsy is increasingly used in the diagnosis and treatment of lung cancer. Because of the extremely low DNA level of circulating tumor, the sensitivity and specificity of liquid biopsy based on blood samples are limited. Tumor cells is enriched in MPE. The detection of cell-free DNA, extracellular vesicles and microRNA in MPE will be helpful to the diagnose, treatment and assess prognosis of patients with lung cancer. This review aims to discuss the research progress of liquid biopsy based on MPE in the diagnosis and treatment of lung cancer patients. .
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Malignant pleural effusion (MPE) is one of the common complications of tumor. Acupuncture-moxibustion therapy has several advantages for treatment of MPE. Acupuncture is regarded as a complex individualized intervention, and its characteristics of TCM is difficult to be reflected by strict randomized controlled trials. The registry study provides more possibilities for the data collection of individualized diagnosis and treatment under the guidance of the overall concept and syndrome differentiation, and is more suitable for data management and collection of large samples and multi-center trials in the real-world study. It has become an opportunity to carry out real-world study of acupuncture for MPE. There are many challenges in the registry study of acupuncture for MPE. However, it is of great significance to collect real-world data of acupuncture for MPE to improve the clinical effect of MPE and provide a new clinical research method for acupuncture in tumors and related complications.
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OBJECTIVE：To evaluate the efficacy and s afety of different administration routes of bevacizumab in the treatment of malignant pleural effusion （MPE），and to provide evidence-based reference for rational use of drugs in clinic. METHODS ： Retrieved from Cochrane L ibrary，PubMed，Embase，VIP，CNKI，Wanfang database and CBM ，clinical studies were collected ， about bevacizumab combined with or without chemotherap eutic drugs （trial group ）versus chemotherap eutic drugs （control group ） in the treatment of MPE under different administration routes. After literature screening and data extraction ，the quality of RCTs was evaluated by using bias risk evaluation tool recommended by Cochrane Systematic Evaluator Manual 5.3. Newcastle-Ottawa scale was used to evaluate the quality of the retrospective study. Meta-analysis was performed by using Rev Man 5.3 software， network Meta-analysis was performed by using Stata 13.0 software and intervention measures were ranked by using R 3.6.1 software. RESULTS ：A total of 29 studies were included ，involving 21 RCTs and 8 retrospective studies ，including 2 254 patients. The studies involved 5 intervention measures ，such as bevacizumab+chemotherap eutic drugs （thoracic perfusion ），bevacizumab+ chemotherapeutic drugs （ivgtt），bevacizumab（thoracic perfusion ），chemotherapeutic drugs （thoracic perfusion ），chemotherapeutic drugs（ivgtt）. Network Meta-analysis showed there was no statistical significance in bevacizumab+chemotherap eutic drugs （thoracic perfusion）and bevacizumab+chemotherap eutic drugs （ivgtt）[OR＝0.81，95％CI（0.13，4.60），P＞0.05]，chemotherapeutic drugs （thoracic perfusion ）and chemo therapeutic drugs （ivgtt）[OR＝ 0.47， 95％ CI （0.07，3.10）， P＞0.05]， bevacizumab + Z19SCHX202） chemotherapeutic drugs （ivgtt） and chemotherap eutic drugs （ivgtt） [OR＝0.56，95％ CI（0.27，1.20），P＞0.05]. Total 、 response rate of bevacizumab + chemotherap eutic drugs （thoracic perfusion ） [OR＝3.10，95％ CI（2.10，4.50），P＜ 0.05]，bevacizumab（thoracic perfusion ）[OR＝1.90，95％CI （0.99，3.90），P＜0.05] were significantly higher than chemotherapeutic drugs （thoracic perfusion ）. Network Meta-analysis ranking showed that bevacizumab + chemotherapeutic drugs （ivgtt）＞ bevacizumab + chemotherapeutic drugs （thoracic perfusion ）＞ bevacizumab（thoracic perfusion ）＞chemotherapeutic drugs （ivgtt）＞chemotherapeutic drugs （thoracic perfusion ）. The incidence of elevated blood pressure [RR= 2.64，95％CI（1.56，4.43），P＝0.000 3] and proteinuria [RR ＝3.24，95％CI（1.79，5.86），P＝0.000 1] in trial group were significantly higher than control group. There was no statistical significance in the incidence of granulo- cytopenia [RR ＝0.94，95％CI（0.81，1.09），P＝0.41] or nausea and vomiting [RR ＝0.87，95％CI（0.73，1.03），P＝0.10] between 2 groups. Compared with chemotherapy alone ，bevacizumab combined chemotherapy could not prolong the total survival time of patients，but can improve the progression-free survival time. CONCLUSIONS ：Bevacizumab combined with chemotherapy can improve the efficacy of MPE patients ，but thoracic perfusion can increase the risk of proteinuria and elevated blood pressure.
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Background and Objective: Malignant pleural effusion (MPE) is a known complication of both thoracic and extrathoracicmalignancies. A detailed clinical and investigative profile of patients presenting with MPE would allow us to intervene early inthe disease and would ensure a better prognosis.Materials and Methods: A prospective study of 60 cases of MPE was carried out in the Department of Thoracic Medicine andCardiothoracic surgery, Thanjavur Medical College Hospital, Thanjavur, from October 2017 to May 2018, with respect to age,sex, clinical findings, biochemical analysis, radiological, cytological investigations, and histopathology.Results: The most common age group of MPE is between 60 and 70 years, male-to-female ratio was 1:1. The right-sidedpleural effusion was a more common finding compared to the left-sided effusion; pleural fluid biochemical analysis revealed amean adenosine deaminase of 23.97 u/l, mean pleural fluid protein/serum protein ratio was 0.95, and mean pleural fluid glucosewas 38.75 mg/dl. Of 60 cases, the most common cause of MPE was adenocarcinoma of lung which accounted for 30 cases,followed by metastatic carcinoma 24 cases and squamous cell carcinoma lung 3 cases and pleural mesothelioma in 3 cases.Conclusion: Pleural fluid cytology analysis for malignant cells was sufficient to diagnose MPE in 85% of cases, and in remainingcases, pleural biopsy can be helpful. The most common primary in cases of MPE was adenocarcinoma of lung.
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Comparar el uso del talco estéril versus yodopovidona como agentes químicos en pleurodesis para el tratamiento del derrame pleural maligno.Materiales y Métodos: Estudio clínico, analítico, observacional, prospectivo, el cual incluyó 12 pacientes con diagnóstico clínico e histopatológico de derrame pleural maligno, a quienes se les practicó pleurodesis empleando talco estéril y yodopovidona.Resultados : Edad promedio fue de 46,25 ± 17,3 y la neoplasia primaria más común fue el cáncer de mama, representando el 50% de los casos estudiados. El grupo de pacientes tratados con yodopovidona tuvo 100% de efectividad en la fusión pleural posterior a la pleurodesis, y presentaron menos complicaciones durante el procedimiento y 24 horas posteriores al mismo con respecto al grupo tratado con talco estéril, el cual tuvo un 71,4% de efectividad y un 28,6% de falla al procedimiento; asimismo, estos últimos presentaron mayor porcentaje de complicaciones. Por otra parte, no se evidenció recidiva del derrame pleural en los 30 días de valoración posteriores al procedimiento. Estas diferencias no fueron estadísticamente significativas.Conclusiones : Ambos agentes esclerosantes fueron eficaces para lograr la fusión de las pleuras en pacientes con derrame pleural maligno, siendo el talco estéril el agente con mayor tendencia a producir complicaciones y fallo del procedimiento, en comparación a la yodopovidona(AU)
To compare the use of sterile talc versus povidone-iodine as chemical agents on pleurodesis for the treatment of malignant pleural effusion.Materials and Methods : A total of 12 patients with clinical and histopathologic diagnose of malignant pleural effusion were enrolled in a clinical, analytic, observational and prospective trial, to whom sterile talc and povidone-iodine pleurodesis was applied.Results : The mean age was 46,25 ± 17,3 and the most common primary neoplasm was breast cancer, which was present in 50% of the surveyed cases. The group of patients who received povidone-iodine had 100% of effectiveness on post-pleurodesis pleural fusion, and had fewer complications during the procedure and 24 hours afterwards vis-à-vis the group who received sterile talc powder, which had 74.4% of effectiveness and 28.6% of procedure failure; furthermore, the last mentioned had higher percentage of complications. Moreover, there was no evidence of recurrence of pleural effusion in the 30 days post-procedure assessment.Conclusions : Both sclerosant agents were efficient to accomplish pleural fusion in patients with malignant pleural effusion, with sterile talc being the agent with higher tendency to generate more complications and procedure failure compared to povidone-iodine(AU)
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Humans , Male , Female , Adult , Middle Aged , Povidone-Iodine , Pleural Effusion, Malignant/pathology , Pleurodesis , General Surgery , Talc , Breast Neoplasms , Clinical Diagnosis , SterilizationABSTRACT
Background@#Malignant pleural effusion (MPE) is a complicated condition of patients with advanced tumors. Further dissecting the microenvironment of infiltrated immune cells and malignant cells are warranted to understand the immune-evasion mechanisms of tumor development and progression.@*Methods@#The possible involvement of microRNAs (miRNAs) in malignant pleural fluid was investigated using small RNA sequencing. Regulatory T cell (Treg) markers (CD4, CD25, forkhead box P3), and Helios (also known as IKAROS Family Zinc Finger 2 [IKZF2]) were detected using flow cytometry. The expression levels of IKZF2 and miR-4772-3p were measured using quantitative real-time reverse transcription polymerase chain reaction. The interaction between miR-4772-3p and Helios was determined using dual-luciferase reporter assays. The effects of miR-4772-3p on Helios expression were evaluated using an in vitro system. Correlation assays between miR-4772-3p and functional molecules of Tregs were performed.@*Results@#Compared with non-malignant controls, patients with non-small cell lung cancer had an increased Tregs frequency with Helios expression in the MPE and peripheral blood mononuclear cells. The verified downregulation of miR-4772-3p was inversely related to the Helios+ Tregs frequency and Helios expression in the MPE. Overexpression of miR-4772-3p could inhibit Helios expression in in vitro experiments. However, ectopic expression of Helios in induced Tregs reversed the effects induced by miR-4772-3p overexpression. Additionally, miR-4772-3p could regulate Helios expression by directly targeting IKZF2 mRNA.@*Conclusion@#Downregulation of miR-4772-3p, by targeting Helios, contributes to enhanced Tregs activities in the MPE microenvironment.
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BACKGROUND@#The aim of this study is to systematically evaluate the efficacy and adverse effects of Lobaplatin and Cisplatin in the treatment of malignant pleural effusion.@*METHODS@#The databases of Medline (PubMed), Embase, Web of Science, Cochrane, Wanfang, CNKI and VIP were retrieved so as to search the studies about the randomized controlled clinical trials (RCT) that compared the Lobaplatin and Cisplatin for malignant pleural effusion. The main outcome indicators include objective response rate, complete response, partial response, nephrotoxicity, chest pain, gastrointestinal reaction, myelosuppression, fever response and hepatotoxicity. Relative risk was used as the effect size, which was expressed as 95% confidence interval. The meta-analysis was performed using Stata 14.0 statistical software.@*RESULTS@#A total of 12 RCTs and 720 MPE patients were included. The results showed that the ORR (RR=1.27, 95%CI: 1.15-1.40, P<0.001), CR (RR=1.39, 95%CI: 1.09-1.78, P=0.007), PR (RR=1.21, 95%CI: 1.02-1.42, P=0.026) in LBP thoracic perfusion chemotherapy were significantly higher than those in DDP thoracic perfusion chemotherapy. The incidence of nephrotoxicity (RR=0.31, 95%CI: 0.13-0.71, P=0.005) and gastrointestinal reactions (RR=0.44, 95%CI: 0.31-0.62, P<0.001) in the LBP group were significantly lower than those in DDP group.@*CONCLUSIONS@#Compared with DDP pleural perfusion chemotherapy, the ORR, CR and PR of LBP pleural perfusion chemotherapy for MPE are significantly better than DDP, and its nephrotoxicity and gastrointestinal reactions are remarkably lower than DDP.
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Humans , Antineoplastic Agents , Therapeutic Uses , Cisplatin , Therapeutic Uses , Cyclobutanes , Therapeutic Uses , Organoplatinum Compounds , Therapeutic Uses , Pleural Effusion, Malignant , Drug Therapy , Randomized Controlled Trials as TopicABSTRACT
Lung cancer is the most commonly diagnosed cancer worldwide. Malignant pleural effusion (MPE) caused by advanced lung cancer seriously affect the patients' quality of life and prognosis. The management of MPE includes thoracentesis, pleurodesis, indwelling pleural catheters and drug perfusion in pleural cavity. Vascular endothelial growth factor (VEGF) and its receptor are a group of important ligands and receptors that affect angiogenesis. They are the main factors controlling angiogenesis, and they play an important role in the formation of MPE. Bevacizumab is a recombinant humanized VEGF monoclonal antibody, competitively binding to endogenous VEGF receptor. Bevacizumab can inhibit new blood vessel formation, reduce vascular permeability, prevent pleural effusion accumulation and slow the growth of cancers. This review aims to discuss the progress of bevacizumab in the treatment of MPE caused by non-small cell lung cancer (NSCLC), and explore the clinical application, efficacy, safety and future direction of bevacizumab. .
Subject(s)
Humans , Antineoplastic Agents , Therapeutic Uses , Antineoplastic Agents, Immunological , Therapeutic Uses , Carcinoma, Non-Small-Cell Lung , Pathology , Pleural Effusion, Malignant , Drug Therapy , Pleural Neoplasms , Drug TherapyABSTRACT
Objective@#To provide reference for clinical screening of individualized therapy by detecting the drug susceptibility of primary tumor cells derived from malignant pleural effusion (MPE) of the patients with non-small cell lung cancer (NSCLC). @*Methods@#MPE specimens were collected from 20 patients diagnosed as NSCLC by histopathology. They were separated by density gradient centrifugation cultured in vitro to remove non-tumor cells, and then primary cell lines were established. The half-inhibitory concentrations (IC 50 ) of conventional anti-tumor chemotherapy drugs on primary tumor cells were determined by the MTT method, and an absolute predictive value (R) was obtained by comparing the IC 50 with the theoretically calculated value of maximum plasma concentration (IC 50m ). Last, the R value was compared with the actual clinical efficacy of the NSCLC patients. @*Results@#After 20 MPE samples were pretreated and cultured for 4 generations, the primary tumor cell lines passaged stably in vitro were established successfully. Papanicolaou staining confirmed that these tumor cell lines had the characteristics of cancer cells, and their purity was nearly 100% under the microscope. The MTT results showed that the invalid IC 50 values beyond the upper limit of test concentration could be further included in the following evaluation on the therapeutic effect of patients when R values were used. When R values between 0.5 and 2.0 and more than 2.0 were used for predicting the actual therapeutic effect as disease stability and disease progression, respectively, the overall consistency between R value and actual therapeutic effect was 77% (10/13) in six patients with complete history of chemotherapy. @*Conclusion@#The primary culture of tumor cells in MPF and the detection of drug sensitivity have the clinical application value in predicting the actual therapeutic effect of NSCLC patients.
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Objective To investigate the diagnostic value of B7-H3 and carcinoembryonic antigen (CEA) on diagnosis of malignant pleural effusion (MPE).Methods We collected and analysed the expression of B7-H3 and CEA in 40 MPE cases and 22 cases of benign pleural effusion (BPE) using enzyme-linked immunosorbent assay (ELISA).Receiver operator characteristic curves (ROC) were drawn according to the expression of B7-H3 and CEA, calculated diagnosis sensitivity, specificity and the area under curve (AUC).Results The diagnosis sensitivity of B7-H3 was 62.5％, specificity 81.0％, with the AUC of 0.777;similarly, The diagnosis sensitivity of CEA was 72.5％, specificity 81.0％, with the AUC of 0.850.Higher AUC of 0.910 was gained in combination ROC, with sensitivity and specificity of 72.5％, 81.0％, respectively.Conclusion B7-H3 and CEA could be available diagnosing markers for MPE.Combined applications of B7-H3 and CEA have higher AUC.They may be widely applied in future clinical practice.