Clinical Observation Of Bleomycin And Cisplatin To Treat Malignant Pleural Effussion

Malignant pleural effusion (MPE), fluid accumulations secondaryto pleural metastasis of lung cancer or other malignancy, or pleuralprimarily tumou, is a common complication in the advanced stage ofmalignant tumor. It is prevalent and vexing problem in patients withadvanced malignant disease. Many of these patients experiencemarked respiratory discomfort although other aspects of the diseasewould allow them to lead active and productive lives. Generally speaking, the development of MPE means badprognosis. The average life span of MPE patients is about 6 months.MPE Median survival following diagnosis ranges from 3 to 12 monthsand is dependent on the stage and type of the underlying malignancy.The shortest survival time is observed in malignant effusionssecondary to lung cancer and the longest in ovarian cancer, whilemalignant effusions due to an unknown primary have an intermediatesurvival time. After the diagnosis of MPE and the identification of primarytumour, proper therapy should be taken. It is most judicious to beginwith the current standard treatment for advanced or unresectbleoncoma. The type of the primary malignancy is very important. Breastcancer often respond to systemic forms of therapy, includingchemotherapeutic agents and houmonal manipulations. Lymphomaoften shows response to localized irradiation and intravenouschemotherapy. It shouldbe clear to the clinician that the effusion iscaused by a malignant condition, that the effusion producesrespiratory symptoms that arerelieved by removal of the effusion, andthat the effusion fails to respond to standard cancer therapies.Treatment options for malignant pleural effusions are determinedby several factors: symptoms and performance status of the patient,the primary tumour and its response to systemic therapy, and lungre-expansion following pleural fluid evacuation. Although.More satisfactory methods for controlling these effusions havebeen developed. But the methods are diverse and provide variableresults.In some patients, it is no helpful to relieve the amount of pleuraleffussion with standard treatment. Despite recent advances inchemotherapy and radiation therapy, there are still many patients whoare disabled by recurrent effusions. Despite their lack of direct effecton tumour growth, thchniques have been developed to effect localcontrol of pleural fluid accumulation and alleviate the associatedrespiratorydistress.Bleomycin is a kind of antineoplastic agent, which can inhibit thesynthesis of DNA. Intrapleural BLM has low toxicities, high locallevel, good tolerance in treatment of MP. BLM is a mild sclerosingagent to treat MPE. DDP is platinum chemotherapeutics. It is a kind ofwidely used intrapleural drugs. It can inhibit the synthesis of DNA,RNA and protein, induce apoptosis of tumour cell, enhance cellularimmunity. It has certain curative effect to MPE. It is often used inclinical trial with intrapleural chemotherapeutics In this study, 41cases underwent intrapleural instillation randomly bleomycin orcisplatin, to compare the advantage and disadvantage of these twodrugs to treat MPE.In this study, 41 patients with MPE were treated with small boreintercostals catheters. They were randomized to BLM (n=21) or DDP(n=20). The BLM patients treated with intrapleural bleomycin (BLM),and the DDP patients treated with intrapleural cisplatin (DDP). InBLM group, 19 cases with nonsmall-cell lung cancer (NSCLC), 2cases with pleural metastasis of ovarian cancer;11 case were male, 10cases were female;the age ranged from 47~63 years old, the averageof age was 55.3 years. In DDP group, 17 cases with NSCLC, 3 caseswith pleural metastasis of breast cancer;11case were male, 9 caseswere female;the age ranged from 45~64 years old, the average of agewas 53.2 years. All patients' curative effect were evaluated by chestfluoroscopy. We apply WHO standard to evaluate therapeutic effect.BLM patients' total success rate (complete and partial response rate)was 85.7%, success rates of once intrapleural injection was 71.4%;DDP patients' total success rate was 55.0%, success rates of onceintrapleural injection was 5.0%. The difference between the twogroups' success rates of once intrapleural injection was significant(P<0.01), and the difference of total success rates was significant(P<0.05).The result of BLM group, Similar with the results from Bitran'sreport (20cases, success rate was 85%), Wang Si wen's report(16cases, success rate of once intrapleural injection was 75%), XiangYing's report (40 cases, success rate of once intrapleural injection was90%). The result of DDP group, Similar with the results from Li Liyun's report (25 cases, success rate was 62.5%). It reveals thatintrapleural BLM has a better result to treat MPE, and has a highersuccess rate of once intrapleural injection. It is usually several times ofintrapleural DDP to treat MPE.We apply WHO toxicity standard to evaluate adverse reaction.The main adverse effects of intrapleural BLM were chest pain andfever. The chest pain can be relieved to mix lidocaine into theinjection, and it often need not to treat. Fever can be controlled bycorresponding treatment. Chest pain and fever may last for 24h. Chestpain and fever was rare in DDP patients, but nausea, vomiting andbone marrow suppression was common. Intrapleural DDP was notsuitable for old weak patients, or advanced stage of malignant tumor.Above all, it Intrapleural BLM is a ideal management to has ahigh success rate, low toxicities, good tolerance in treatment of MPEwith intrapleural BLM. treat MPE. Association with small boreintercostals catheters, it is easy, safy and little injury for patients. It isworthy to be advocated in clinic.