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OBJECTIVE:To systematically evaluate therapeutic efficacy and safety of recombinant mutant human tumor necrosis factor(rmhTNF)versus pleural perfusion of cisplatin in the treatment of malignant pleural effusions,and to provide evidence-based reference in clinic. METHODS:Retrieved from PubMed,Cochrane Library,Web of Science,CJFD,Wanfang database,VIP and CBM,RCTs about rmhTNF(trial group)vs. cisplatin(control group)in the treatment of malignant pleural effusions were included. Meta-analysis was conducted by using Rev Man 5.3 statistical software after quality evaluation and data extraction with Cochrane system evaluator manual 5.3.0. RESULTS:A total of 7 RCTs were included,involving 478 patients. Meta-analysis showed that clinical total response rate of trial group [RR=1.43,95%CI(1.27,1.62),P<0.001] was significantly higher than that of control group,with statistical significance. There was no statistical significance in the incidence of gastrointestinal reaction[RR=1.15,95%CI(0.73,1.80),P=0.55],chest pain[RR=1.12,95%CI(0.73,1.73),P=0.60],fever[RR=0.62,95%CI(0.35,1.08),P=0.09] and myelosuppression[OR=0.94,95%CI(0.57,1.54),P=0.79] between trial group and control group. CONCLUSIONS:Pleural perfusion of rmhTNF is significantly better than cisplatin in the treatment of malignant pleural effusions. The incidences of gastrointestinal reaction,chest pain,fever and myelosuppression induced by rmhTNF were similar to those induced by cisplatin.
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Malignant pleural effusions and ascites are common complications in various cancers, which are difficulties in clinical treatment. Elemene injection, with the main ingredient ofβ-elemene, extracted from Chinese herbal medicine Curcumae Rhizoma, has broad-spectrum antitumor activity by inhibiting proliferation and inducing apoptosis in several types of solid tumor cells. This article reviewed the clinical experience of Chinese scholars in treating malignant pleural effusions and ascites with elemene injection.
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Objective To observe the efficacy of Kang'ai Xiaoshui Cream in the treatment of malignant pleural effusions.Methods Forty-three patients with malignant pleural effusions were randomly recruited into a treatment group and a contrast group..The treatment group included 22 cases were treated by Kang'ai Xiaoshui Cream externally,while the contrast group covered 21 cases were treated by IL-2.Results The effective rate of pleural fluid was 63.64%and 57.14% in the treatment group and the contrast group respectively,not showing distinct difference(P>0.05).The positive reactions of pleura adhesion,improvement of life quality,and the adverse reactions of the treatment group were better than contrast group (P<0.05).Conclusion Kang'ai Xiaoshui Cream Can effectively control the malignant pleural effusions and improve the life quality of patients.
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Objective To evaluate the therapeutic effect and possible mechanism of intrapleural administra- tion of cisplatin bound to activated carbon particles for treating malignant pleura] effusions(MPE). Methods ①60 patients with MPE confirmed in the Third Hospital of Changzhou and the Second Hospital of Changzhou from 2004 to 2007 were randomly divided into treatment group (n=30)and control group(n=30). Chest catheters were inserted percutaneously into the pleural space to drain the effusions. Cisplatin mixed with activated carbon particles for the treatment group and only cisplatin for the control group were injected into pleural cavity. Whether above-mentioned treatment should be repeated was determined by ultrasonic B every week until up to four times. Curative effect and side-effect were compared between two groups a month later. ②20 cases, randomly selected from both groups respectively, underwent whole body and chest SPECT scan to image lymphatic system by means of 99Tcm-DX after effusions drainage but before intrapleural injection of drug. Cases whose imaging graphics were abnormal would undergo the above SPECT again 2 weeks after intrapleural injection of drug so as to find changes in imaging graphics. Results ① The overall response rate was significantly higher in treatment group than in control group(100% (30/30) vs 66.7% (20/30), χ2=12.00, P<0.01)and that intrapleural injection was needed only once in most cases. Gastrointestinal upset and leucoponia were less and milder in treatment group than in control group (16.7% (5/30) vs 30.0% (9/30) and 6.7% (2/30) vs 20.0% (6/30) respectively),but there was no statistical difference between the two groups(χ2=1.49 and 1.30,P>0.05). ②The rate of improvement in lymphatic imaging was significantly higher in treatment group than in control group (78.6% (11/14) vs 37.5% (6/16),P<0.05). Conclusion The treatment of malignant pleural effusions with intrapleural administration of cisplatin bound to activated carbon particles is extremely effective and safe, and can improve lymphatic drainage as well.
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Objective: To investigate the association of nuclear DNA content and vascular endothelial growth factor (VEGF) and p53 expression with therapeutic response of malignant pleural effusion and their value in predicting the prognosis of wet lung cancer. Methods: The survival periods of 43 lung cancer patients with pleural effusions were followed up. The DNA content of 39 patients was measured by the image cytometry (ICM) and the expression of VEGF and p53 was determined by Envision immunohistochemical method. Twenty-nine patients were given bleomycin or interleukin-2 intrathoracically after drainage. Results: DNA aneuploid had a tendency to correlate with therapeutic efficacy of malignant pleural effusion (P = 0. 054). Cox multivariate analysis showed that only p53 expression was independent prognostic factor for lung patients with pleural effusion (P = 0.05). The median survival time of patients was (10.4 ± 3.5) months for p53-negative patients and (2.8 ± 0.6) months for p53-positive patients (log rank = 0.013 2). One-year survival rate was 17.7% for p53-negative patients and 0% for p53-positive patients. Conclusion: DNA content measured by ICM tended to correlate with the therapeutic efficacy of malignant pleural effusion; p53 expression is a unique independent prognostic factor for lung cancer patients with pleural effusions.
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Objective To evaluate the efficacy and adverse effects of bleomycin combined with Interleukin-2 for malignant pleural effusions in patients with NSCLC. Methods Malignant pleural effusions were excreted cleanly from indwelling chest tube, bleomycin and Interleukin-2 were injected thorax. Results Total survival rate is 88.5 %, only part patients have fever, chest pain, tetter, nausea. Conclusion Bleomycin combined with Interleukin-2 treat patients with malignant pleural effusion from NSCLC, the efficacy are better, the adverse effects are tolerabe.
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Tradicionalmente, la pleurodesis se ha empleado en enfermos con neoplasias malignas confirmadas y esperanza razonable de sobrevida, complicados con derrame pleural recurrente de más de la mitad del hemitórax, con disnea que mejora con la evacuación del líquido, un pulmón que puede expandirse hasta la pared torácica y la expectativa de un periodo de sobrevida razonable. La evacuación del líquido y la inducción de esclerosis pleural se puede intentar en la cama del enfermo, o en el cubículo de urgencias con un catéter fino o una sonda de mayor diámetro, en una sala de procedimientos por toracoscopía de un acceso con anestesia local y sedación, o bien, en un quirófano con anestesia general por videotoracoscopía, introduciendo sustancias esclerosantes y/o realizando diversos tipos de abrasión sobre las pleuras parietal y visceral. Se propone el empleo de pleurodesis cerrada de primera intención con un catéter pleural o vascular que sirve para evacuar todo el líquido e introducir el agente esclerosante, en enfermos con neoplasias malignas que cursen con derrame pleural de más de la mitad del hemitórax, con disnea o sin ella, y esperanza razonable de sobrevida; según el caso particular, el catéter se puede extraer, previo control radiográfico, dejarlo para repetir la pleurodesis varios días y luego retirarlo o, si falla la pleurodesis, dejarlo in situ para drenar el tórax con una jeringa cada vez que sea necesario, sin preocuparse ya por buscar la pleurodesis en estos enfermos afectados por una neoplasia terminal, y que desean vivir sin disnea los días que les quedan de vida; el procedimiento no es oneroso, se realiza sin necesidad de hospitalización, no requiere sonda torácica ni drenaje pleural y es efectivo en el 90% de los enfermos. El consenso de la información actual no aconseja la pleurectomfa parietal como procedimiento de elección.
Traditionally, pleurodesis has been attempted in patients with confirmed malignant tumors with recurring pleural effusions of more than half the size of the hemithorax, dyspnea that is relieved by evacuation of the fluid, a lung able to reach the chest wall and the expectation of a reasonably long survival period. Pleurodesis can be done at the bedside, the emergency room, in a procedure room by medical thoracoscopy under local anesthesia and sedation, or in the operating room by VATS under general anesthesia, introducing an sclerosing agent and/or producing pleural abrasion by different means. We propose "first contact closed pleurodesis " for patients with an unequivocal diagnosis of malignancy, a pleural effusion of more than half the size of the hemithorax, even if asymptomatic, and the expectation of a reasonably long survival period, using a vascular or pleural catheter to drain the fluid and introduce the sclerosing substance; depending on the chest x-ray, the catheter can be pulled out, left in situ to repeat the introduction of the sclerosing agent or, if this fails, to drain the fluid as often as necessary with a sterile syringe, ignoring the goal to achieve pleurodesis; the procedure is effective in over 90% of cases and non-expensive, can be done on an outpatient basis and does not require a chest tube nor a pleural drainage system. Present day consensus does not support parietal pleurectomy as an elective choice for these patients.
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BACKGROUND: The purpose of this study was to evaluate the usefulness of the pleural fluid carcinoembryonic antigen (CEA) and cytokeratin fragment 19 (CYFRA 21-1) tumor markers as complementary tools for the diagnosis of malignant pleural effusions. PATIENTS AND METHODS: The levels of pleural and serum CEA and CYFRA 21-1 were prospectively assayed in 222 patients with pleural effusions (150 benign effusions, 57 bronchogenic carcinomas and 15 metastatic carcinomas). RESULTS: The levels of pleural fluid CEA and CYFRA 21-1 in the malignant effusions were significantly higher than those in the benign effusions. With a specificity of 95%, the cut off values for the CEA and CYFRA 21-1 in pleural effusions were 5 and 89 ng/ml, respectively. The diagnostic sensitivities of the pleural fluid CEA and CYFRA 21-1 in malignant effusions were 72 and 54%, respectively, whereas using a combination of the two, the sensitivity increased to 87% (p<0.05). CONCLUSIONS : These findings suggest that a combination of the pleural fluid CEA and CYFRA 21-1 in pleural effusions can be useful in the diagnosis of malignant pleural effusions.
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Humans , Carcinoembryonic Antigen , Carcinoma, Bronchogenic , Diagnosis , Keratins , Pleural Effusion , Pleural Effusion, Malignant , Prospective Studies , Biomarkers, TumorABSTRACT
AIM: To evaluate the efficacy, safety and effects on changes of T lymphocyte subsets of mycobacterium phlei and cisplatin in treatment of patients with malignant pleural effusion (MPE). METHODS: 62 patients of MPE were randomly assigned to two groups. The test group was treated once a week lasting for 1-3 weeks with NS 20 ml + mycobacterium phlei 8.6 ?g + cisplatin 40 mg, while the control one with NS 20 ml + cisplatin 40 mg only. The efficacy and changes of T lymphocyte subsets before and after therapy were analyzed separately. RESULTS: The overall response rate in the test group was 87.5 %, which meant significantly higher than that in the control group (P
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AIM: To investigate the therapeutic effects and the toxicity of intrapleural injection of natural growth factors (NGF, with main component of staphylococcal aureus enterotoxin C) in the treatment of patients with malignant pleural effusions. METHODS: Patients with histopathologically confirmed malignant pleural effusions were evaluated for treatment with NGF. Twelve patients with malignant pleural effusions received NGF pleural instilations until the end of the survey. Drugs were administered according to the following schedule: NGF 2000-2500 intrapleural injection twice weekly. The courses stopped when pleural effusions disappeared or severe toxic reactions occurred. RESULTS: A total of 12 objective responses were assessed, including 10 complete responses (83%), and 2 partial responses. Mean time of following up was 11.1 (3-25) months, 11 patients died during the visit, and the mean survival time was 10.2 months, significantly longer than that (
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BACKGROUND: Most of malignant pleural effusions are serous but 8-33% of them are bloody. We wanted to evaluate the relationships between gross appearance and pleural CEA level or results of histocytology in malignancy associated pleural effusions. We also tried to reevaluate the meaning of CEA measurement in histocylogically proved or unproved malignancy associated pleural effusions. METHODS: We studied 98 cases of malignancy associated pleural effusions, 50 cases of histocylologically proven malignant effusions and 48 cases of histologically unproven paramalignant effusions. We had observed gross appearance and conventional laboratory values and CEA levees for pleural effusions. RESULTS: 44.9% of malignancy associated effusions were bloody(63.6% of bloody effusions were histstocytologically proven malignant effusion). 65.0% of malignancy associated pleural effusions which have RBCs numbers over 100,000/mm3 were cytologically proven malignant effusions. 72.7% of cytologically proven malignant effusions had increased pleural fluid CEA level over 10 ng/ml. 58.2% of cases with pleural CEA over 10ng/ml had positive results in pleural histocytology. There was no definable relationships between pleural fluid CEA elevation and RBCs numbers and results of pleural fluid cytology. CONCLUSION: About half of the cases with malignancy associated pleural effusions were bloody. Histocytologically proven malignant effusions were more common in bloody effusion than non-bloody effusion (63.6% Vs 38.9%). But increased red blood cell numbers was not associated with positivity of pleural histocytology. Pleural fluid CEA elevation(over 10 ng/ml) was not correlated with positive pleural histocytology. But pleural fluid CEA elevation was rare In nonmalignant pleural effusions, and than pleural CEA measurement in uncertain pleural effusions maybe helpful to distinguishes its origin.