射频透热联合化疗治疗肺癌恶性心包积液的近期疗效

摘要

背景与目的恶性心包积液为肺癌严重并发症之一,有效治疗方法不多.本研究旨在评价射频透热联合化疗治疗恶性心包积液的近期疗效.方法回顾性分析中南大学湘雅三医院肿瘤科2000年10月-2010年10月收治的肺癌并恶性心包积液的患者55例,分为射频透热联合化疗组(热化组)和化疗组,热化组采用心包穿刺引流心包积液后,给予心包腔内注射顺铂20 mg+地塞米松5 mg,然后进行局部射频透热治疗,患者一般情况改善后行全身化疗,腔内化疗1次-6次,平均3次,热疗每周2次平均6次,腔内温度控制在40.5℃-41.5℃左右并维持60min；化疗组只给予腔内注药和全身化疗.全身化疗方案为长春瑞滨+顺铂,长春瑞滨总量50 mg/m2,顺铂总量75 mg/m2.结果热化组心包积液完全缓解率为54.3％,总有效率为91.4％,化疗组分别为25.0％、70.0％,两组比较有统计学差异(P＜0.05)；治疗后两组生活质量均明显提高,但热化组生活质量的改善优于化疗组,两组KPS评分的变化有统计学差异(P＜0.05)；化疗不良反应主要为消化道毒性和骨髓抑制,两组比较无统计学差异(P＞0.05)；与热疗相关的主要副反应为局部皮肤疼痛(8.6％)和皮下脂肪硬结(5.7％).结论射频透热联合化疗治疗肺癌恶性心包积液近期疗效确切,能显著改善患者生活质量,不增加全身化疗毒副反应,安全性高.%Background and objective Malignant pericardial effusion is one of the serious complications of lung cancer and lack effective treatment methods. The aim of this study is to evaluate the efficacy and safety of radiofrequency hyper-thermia combined with chemotherapy for patients with malignant pericardial effusion caused by lung cancer. Methods Fifty-five patients with malignant pericardial effusion caused by lung cancer were divided into hyperthermia combined with chemotherapy group (combined therapy group) and chemotherapy group. The combined therapy group was treated with radiofrequency hyperthermia after the pericardiocentesis and intracavitary injection (cisplatin 20 mg and dexamethasone 5 mg), when patients' general state of health improved, systemic chemotherapy was performed. The chemotherapy group was treated only with intracavitary injection and systemic chemotherapy. Intracavitary chemotherapy was performed for 1-6 times (average 3 times). Hyperthermia was performed twice per week with an average of 6 times following intracavitary and systemic chemotherapy. The temperature of intracavitary was 40.5 ℃-41.5 ℃ for 60 min during the hyperthermia periods. Systemic chemotherapy consists of cisplatin (75 mg/m2) and vinorelbine (50 mg/m2). Results The complete remission rate (CR) of malignant pericardial effusion was 54.3% and the response rate (RR) was 91.4% in the combined therapy group, while the rates of CR and RR of chemotherapy group were 25.0% and 70.0%, and the differences of CR and RR between the two groups were significant (P<0.05). After treatment, the quality of life improved significantly in both groups, but the combined therapy group had a higher KPS score than in the chemotherapy group (P<0.05). The adverse events associated with the chemotherapy included gastrointestinal toxicity and myelosup-pression, and there were no significant differences between the two groups. The main side effects associated with radiofrequency hyperthermia included local skin ache (8.6%) and induration of subcutaneous fat (5.7%). Conclusion Radiofrequency hyperthermia combined with chemotherapy is effective in treatment of malignant pericardial effusion and can significantly improve the quality of life of patients without increasing the toxicity of chemotherapy, and side effects could be tolerable.