The Treatment Of Advanced Non-small Cell Lung Cancer Companied Hydrothorax

BACKGROUND AND PURPOSE:The non-small cell lung cancer companied with hydrothorax usually means that lung cancer enters into later stage and loses opportunity to be radically treated with surgery. No-surgery measurement is usually adopted to improve life quality. Hydrothorax has tight connection with clinical symptoms. How to control hydrothorax becomes to be the key of treatment.Single thoracic puncture or drainage, thoracic chemotherapy, or pleura exfoliation through thoracoscopy can't achieve good result on such patients. So, we adopted multiple measurement including thoracic puncture and drainage, thoracic and whole-body chemotherapy, and pleura fixation through thoracoscopy on 68 patients, who were divided into 3 groups: hydrothorax with small quantity, hydrothorax with middle quantity, hydrothorax with largequantity. All the measurements were assessed for each group.Method:1. Including and excluding standard:(1) Including standarda. No-small cell lung cancer is verified pathologically. Hydrothorax is indicated by chest X-ray, CT or ultrasonography. b. Stage HI NSCLC and stage IV NSCLC, such as various T4 tumors infiltrating mediastinum, great blood vessel, bronchus, oesophagus, vertebra;N3, opposite lung gate, mediastinum, collarbone superior,oxter lymph nodes could be infringed. Some already have beyond transfer that it extend to liver, bone , brain, adrenal gland etc. The M is one .(2) Excluding standarda. Pathology type wasn't non-small cell lung cancer, b .Lung cancer combination heart failure, c .Patients who are not stage III or stage IV. 2. Assemble the data:68 cases of NSCLC at stage Ill-IVcompanied with hydrothorax were studied from Jun 2000 to Jun 2004. The data include patient name, sex ,age, contact address, contact phonenumber, clinic diagnose, pathology diagnose (include sputum and shed cell in hydrothorax fibre bronchus lens alive check, exploration and vivisect by Thoracoscopy), lymph node transfer, TNM stages,appear in operation, operation manner and complications after operation. 3. Processing:Thoracic puncture was applied on the group with small amount of hydrothorax;thoracic puncture or drainage was applied on the group with middle amount of hydrothorax;thoracic drainage was applied on the group with large amount of hydrothcrax.After hydrothorax was drained out, chemotherapeutant was perfused into thorax, such as DBP, CBP, E-ADM or biology immunity regulator, such as IL-2,spillikin acid bacillus intercostally. In this group silicagel catheter(diameter 0.5 cm) was applied at 7~9 rib at axillamidline under local anaesthesia, which was spend 8-12hr after infusion of medicine. At the same time to intravenous transfusion anti-vomiting and was applied for pleura adhesion chemotherapy. For patients with refractory hydrothorax, we use central vein catheter for drainage 3~4days with low flow amount. On others with malignant hydrothorax, we adopt pleura fixation with talcum powder through Thoracoscopy, except to chemotherapy. (The standard for diagnosis of malignant hydrothorax is the cytological evidence of cancer cell..The curative effect in the near future assessment standard refer to WHO's standard. Completely relieve(CR): the effusion clear away absolutely and keep the condition for more than 4 weeks. Partly relieve(PR): more than 50 percent of effusion reduce and keep the condition for more than 4 weeks.Stabilization(NC): less than 50 percent of effusion reduce and it must be increase less than 25 percent. Disease evolve(PD): the effusion increase more than 25 percent or appear new focus. To account availability percent is according to CR and PR.Result:In 68 patients, 54 of them were proved that their hydrothorax was malignant. The small quantity of hydrothorax group: 10 patients in all, 3 of them were malignant, one patient was hemoid hydrothorax. The middle quantity of hydrothorax group: 28 patients in all, 21 of them were malignant, 10 patients were hemoid hydrothorax. The large quantity of hydrothorax group: 30 patients in all, and all of them were malignant. 14 patients were hemoid hedrothorax. The rate of malignant hydrothorax was 79.4 percent. Cancer cell can't be found in 8 patients in their effusion. But after thoracoscopy and examation of 3-4 pieces of pleura which had been taken from the visceral pleura and parietal pleura, or to brush and spread three pieces in the rib and midriff concer, we found that all of them were malignant.In 10 patients who had a small quantity of hydrothorax(average 200ml). 2 patients were received chemotherapy. One of them was completely relieve(CR), the other was partly relieve(PR). 8 patients were received puncture in thorax and take liquid out. 7 of themwere completely relieve(CR),one of them was stabilization. 4 of them could be receive operation at last. In 28 patients who had a middle amount of hydrothorax(average 800ml).19 patients were completely relieved(CR), 4 patients were partly relieved(PR). The availability was 83 percent. And the left 5 patients have not got better curative effect, 4 NC patients and 1 PD patient adopt thoracoscopy pleura fixation by talcum powder associated with chemotherapy treatment totally.They got CR at last .The availability was 100 percent.In 30 patients who had a large amount of hydrothorax(average 1200ml).20 of them receive thoracic drainage, pleural infusion and chemotherapy treatment totally. The result was that 9 of them were CR, 5 patients were PR, and 6 of them were NC, the availability was 70 percent. The left 10 patients added 6 patients of NC were chosen to fix pleura with talcum powder through Thoracoscopy, associated with chemotherapy treatment totally too. At last, 14 of them were CR, one of them was PR, the total availability was 93.8 percent. One of them was NC, because pleura incrassation abroad, the lung couldn't expand entirely, lung gate submit into frost state, the pleura couldn't conglutinate.In 68 patients , 56 of them received thoracic puncture or drainage, ploural infusion associated with chemotherapy treatment totally. 35 of them were CR, 9 of them were PR, the total availability was 78.6 percent;21 patients were chosen Thoracoscopy pleura fixation with talcum powder. 19 ofthem were CR, one patient was PR, the total availability was 95 percent. It is necessary to relieve pain if patient feel chest pain after operation(2~3day). No one died during operation . Conclusion:For patients who have late stage of the non-small cell lung cancer companied with hydrothorax, comprehensive treatment according to the quantity of hydrothorax, can control hydrothorax effectively, alleviate symptom,obtain the better curative effect.