Perfusion Thalidomide Treatment Of Lung Cancer And Malignant Pleural Effusion Efficacy

Objective:Discussion thalidomide thoracic drainage and pleural perfusion clinicalefficacy, safety and impact on IL-2for lung cancer patients with malignantpleural effusion survival.Methods:1Screening cases: For lung cancer patients from July2012to May2013toour hospital were screened, all cases were confirmed by clinical, pathology,cytology, imaging (B super, CT) diagnosed with lung cancer with malignantpleural effusion, And all of them were treated by clinically line, second-linechemotherapy in patients with end-stage after. Imaging before and aftertreatment were indicators (B super, CT) observed changes in the amount ofpleural effusion, Select patients met criteria for41cases (One patient droppedout test). Where men and women were24cases,16cases, Between the ages of39-72years, mean age58.3years. Small cell carcinoma,squamous cellcarcinoma, adenocarcinoma were6cases (15.0%),9cases (22.5%),25cases(62.5%).Expected survival is more than3months. There were no major organdysfunction,blood(WBC≥3.0×109/L,PLT≥80×109/L,Hb≥80g/L). Liver andkidney function and blood clotting function was normal, signed informedconsent.2Grouping method:Using the method completely randomized.Allpatients will be randomly divided into two groups.A control group of20patients,Closed thoracic drainage of pleural perfusion combined interleukin-2.Experimental group of20patients,In the control group on the basis ofthalidomide in combination with oral contrast observation four weeks, afterwhich the experimental group had been taking thalidomide to diseaseprogression or intolerance to adverse reactions.All clinical characteristics such as age groups,gender,histological type of lung cancer,KPS score,hematologicalindicators,the test showed no significant difference(P>0.05,Table1.2).3Observed indicators and collection methods:(1)Observedindicators:The general condition of the patient,including pain,physicalcondition,weight,and sleep status;Adverse reactions after treatment such asfever,nausea,vomiting,lethargy,bone marrow suppression;Serum vascularendothelial growth factor (VEGF) levels before and after treatment;blood cellcount (RBC,WBC,PLT);KPS score and chest CT,B extra fine changes;(2)collection methods:KPS score and subjective indicators of adverse reactions tomedication.By a full-time staff collected using a standard scale.Hematologyamount indicators done by hand,Chest CT,chest B-done by the Department ofRadiology,Ultrasound hand.Serum VEGF in strict accordance with theinstructions from my testing.Medication before the test records of allindicators,Repeat testing at different times after the completion of treatmentthese indicators,to observe the changes.After4weeks of treatment,using WHOcriteria to evaluate short-term efficacy of pleural effusion.Quality of life oftwo groups of patients by the general condition of the patient,KPS score,etc.Incontrast,4weeks after treatment,WHO adopts anti-cancer drugs and gradingof acute and performance criteria to determine the toxicity of drugs subacutetoxicity.By enzyme-linked immunosorbent assay to detect VEGFlevels,changes before and after treatment to evaluate its clinical efficacy.4Implementation of treatment:All patients in our department toimplement treatment disposal room.Using fake seldenger puncturethoracentesis,chest built into the single lumen central venous catheter10~12cm.Then slowly closed end of the continuous drainage of pleural fluiddrainage bag.After the pleural fluid drainage catheter as net1to3days,afterthe drainage outflow and no pleural effusion confirmed by the B-no smallamount of pleural effusion,or fluid can not be with drawn, Interleukin-2500000IU1-2times a week, two weeks into a course of treatment,1-2courses.Inthe control group,the experimental group basis,from the first day ofchemotherapy bedtime oral thalidomide100mg.If there is no adverse reaction,one week after the increase to200mg, Maintain this dose until diseaseprogression or severe adverse reactions. All patients were supplemented withoptimal symptomatic and supportive treatment (including nutritionalsupport,anti-tumor medicine,pain,etc).5Data processing:Software uses SPSS17.O,measurement data werex±s,pre-treatment metods using independent sample t test drug,(Independentsample t test). After treatment comparison analysis of variance with repeatedmeasures design(Analysis of variance for repeated measurement data).Countdata prior to treatment with composition ratio (%).After treatment with therate (%)said that,treatment methods are used chi-square test(Chi-squaretest),significance level is P=0.05.Drawing with SPSS17.O software.Result:The experimental group and the control group of40patients,werecompleted four weeks of treatment,to evaluate the efficacy and toxicity.①termeffect:Experimental group of20patients,CR3cases, PR9cases,SD6cases,PD2cases.RR,DCR rates were60.00%and90.00%.There were CR1case,PR6cases,SD7cases,PD6cases.RR,DCR rates were35.00%and65.00%in the control group. Two groups of patients efficiently, the differencewas not statistically significant (P>0.05). Clinical benefit rate, the differencewas statistically significant (P<0.05).②CBR:Experimental treatment groupand the control group were evaluated after4weeks，Experimental group of20cases,16cases of benefit, four cases did not benefit, clinical benefit rate of80%.20cases in the control group,5cases of benefit and15patients did notbenefit, clinical benefit rate of25%.The two groups, the clinical benefit ratewas higher test group, and the difference was statistically significant(P<0.05).③Adverse reactions:Referring to the World Health Organization(WHO) anti-cancer drugs in acute and subacute toxicity indexingstandards,divided into0-Ⅳ degree.Two main adverse reactions werefever,fatigue,drowsiness, peripheral neurotoxicity,rash,nausea,vomiting,bothⅠ-Ⅱ degree of adverse reactions,Ⅲ-Ⅳ degree no adverse reactions occurredduring treatment.The experimental group the incidence of these adverse reactions were30%,20%,35%,5%,10%,10%.Compared with the controlgroup,the difference was not statistically significant(P>0.05).Hematologictoxicity mainly as hemoglobin and thrombocytopenia,the incidence of twoequivalent the difference was not statistically significant(P>0.05).The twogroups were no significant leukopenia occurred.④Determination of serumlevels of growth factors vascular endothelial: Between the twogroups,experimental group and control group before treatment VEGF levelswere significantly (P>0.05). VEGF levels were statistically significantdifferences between the experimental group and the control group aftertreatment(P<0.05).Comparison group:Experimental group before and aftertreatment difference was statistically significant (P<0.05).The control groupbefore and after treatment was significantly (P<0.05).⑤Comparativesurvival：Experimental group3months100%(20people)，6months80%(16people)，9months30%(6). Control group：3months95%(19people)，6months40%(8)，Nine months5%(1). Two groups of patients three monthssurvival contrast, the difference was not statistically significant (P>0.05);6-month and nine-month survival rate of contrast,the difference wasstatistically significant（P<0.05）.Conclusion:1Thalidomide treatment of pleural perfusion lung cancer combined MPE,although there is no obvious improve efficiency, but the disease control rateand clinical benefit in patients were significantly improved,However,thehematologic and non-hematologic toxicity was no significant difference intoxicity2Thalidomide treatment of pleural perfusion lung cancer with MPE, andrelatively simple chest perfusion can significantly reduce serum VEGF levelsin patients.3Thalidomide treatment of lung cancer and MPE, significantlyimproved patient survival, survival was significantly prolonged.