| Introduction:Malignant ascites is caused by the pathological accumulation of fluid in the cavity through the primary tumor in the peritoneal cavity or other tumors out of peritoneal cavity, which is a common complication in patients with advanced cancer. The rapid increase of ascites will produce a lot of symptoms which leads to decreased the quality of life, and malignant ascites is an independent risk factor for prognosis.At present, the treatment for malignant effusion is mainly palliative treatment, it have a lot of methods, and the efficacy of various treatments is different.The celiac hyperthermic perfusion chemotherapy is an effective method to control the local symptoms, which can delay the progression of disease, and it is widely used in cancer treatment.Lobaplatin, the third generation of platinum drugs, it has similar anti-tumor mechanism with cisplatin, it forms the DNA adduct to affect the proliferation of tumor cells.Lobaplatin has many advantages, including good stability, wide antitumor spectrum,strong anti tumor activity.the treatment effect is similar with cisplatin and carboplatin,it also has no cross resistance with other platinums, and has other notable features,including low toxic and less side effects.Sodium Santharidinate and Vitamin B6 Injection(Aiyishu) is an antitumor drugs which is composed of the Chinese herbal medicine of cantharides acid sodium and vitamin B6. Studies have shown that cantharidate sodium both have antitumor and attenuated effects, it also can improve the immune function of cancer patients,so it is a commonly used as anticancer drugs in cancer treatment.At present, platinum is the foundation in the chemotherapy of malignant ascites. The molecular composition of each generation of platinum drugs is different. Every platinum both have advantages and disadvantages in peritoneal metastasis tumors as a different mechanism.It is important to find the proper chemotherapy drugs, which both have high sensitivity and selectivity for tumor tissue, To achieve a satisfactory results for cancer treatment with low toxicity and less side effects, which has great significance for the prognosis and treatment of malignant ascites. In the face of various intra drugs for malignant ascites with different mechanisms, how to improve the control rate of malignant ascites and how to choice the combination scheme for the treatment of malignant ascites also need to discussed. Aims:To observe the effecacy and safety of different programs, including cisplatin, Lobaplatin and combination sodium santharidinate and vitamin B6 with lobaplatin by celica hyperthermic perfusion in the treatment of malignant ascites.In order to improve the effecacy of malignant ascites, in the same time to reduce the side effects.To guide and standardize the treatment of malignant ascites. Case source:Collected 90 cases, including gastric tumor patients and ovarian tumor patients with a medium or heavy level for ascites, who see a doctor in the oncology department of the Yan An university affiliated Hospital from November 2013 to November 2013. Every case was confirmed by pathology and cytology, those patients were randomly divided in three groups, including cisplatin group(30 cases), lobaplatin group(30 cases) and lobaplatin + Aiyishu group(30 cases). Methods:To test the balance of clinical characteristics in those groups after sectionalization, including patient age,gender, KPS score and all. All patients received systemic chemotherapy before received the local treatment. After completely drainaged the malignant ascites, then heading 1500-3000 ml normal saline to 43-45 ℃by the extracorporeal circulation heat filling machine, perfusing those heated normal saline to peritoneal cavity. Next, continued circulatory hyperthermia perfusion about 60 minutes, finally,To left about 2000 ml fluid with 43 degrees Celsius in the peritoneal cavity.When finish those steps, respectively to dispose those groups as follows: lobaplatin +AIYi Shu group: Pouring chemotherapy liquid into abdominal cavity with lobaplatin 30mg/m2+ AIYi Shu 50 ml, once a week, the total course of treatment was 2 weeks; The lobaplatin group: Pouring chemotherapy liquid into abdominal cavity with lobaplatin 30mg/m2, once a week, the total course of treatment was 2 weeks; the cisplatin group: Pouring chemotherapy liquid into abdominal cavity with cisplatin 30mg/m2, once a week, the total course of treatment was 2 weeks. Evaluation of curative effect:Including recent efficacy, improvement of quality of life, side effects. The standard for recent efficacy as WHO for malignant ascites’ curative effect. The standard for improvement of quality of life according to the Karnofsky performance status score; side effects according to the toxicity response criteria NCl2 CTC 3.0 published by National Cancer Institute common. Results:1.Before treatment, three groups was no significant difference in age, sex, KPS score, tumor stage, and ascites volume(p > 0.05).2.The curative efficacy: The objective response rate(ORR) in the treatment of cisplatin group, lobaplatin group, lobaplatin+Ai Yi Shu group were respectively 40%, 43.3% and 76.7%; lobaplatin+Ai Yi Shu group’s objective response(ORR) was significantly higher than other two groups(p<0.0166).3. Improvement of quality of life: The total rate in improvement of quality of life in cisplatin group, lobaplatin group, lobaplatin+Ai Yi Shu group were respectively 36.7%, 50% and 80%, lobaplatin+Ai Yi Shu group’s rate was significantly higher than the other two groups(p<0.0166).4. Side effects: all patients’ main side effects are white blood cells decreased, thrombocytopenia and gastrointestinal toxicity, all side effects is lighter(I, II degree), fewer patients happened serious side effects, after symptomatic treatment, everyone can continuely to finish the treatment; after compare with any two groups we can find that: gastrointestinal toxicity in cisplatin group was significantly higher than the Lobaplatin group(p<0.0166), the thrombocytopenia occurred rate in lobaplatin group was significantly higher than the cisplatin(p<0.0166), and lobaplatin+Ai Yi Shu group ‘s white blood cells decreased rate was significantly lower than the other two groups(p<0.0166). Conclusions:1. After comparing with cisplatin or platinum, we found that lobaplatin+Ai Yi Shu can significantly improve the curative efficacy, and the difference was significant statisticlly.2. there was no significant difference in the efficiency of control the ascites between cisplatin and lobaplatin.3. After comparing with cisplatin or platinum, we found that lobaplatin+Ai Yi Shu can significantly improved patients’ quality of life.4. Sodium Santharidinate and Vitamin B6 can improve the efficacy in the treatment of malignant ascites. Above all, it seems to bring a better safety in the process of treatment. also it has a positive effect in reduce the chemotherapy related toxicity. |
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