重组人血管内皮抑素单药或联合铂类心包腔灌注治疗恶性心包积液

摘要

目的 探讨重组人血管内皮抑素(恩度)单药或联合顺铂(PDD)或者卡铂(Cab)心包腔内灌注治疗恶性心包积液的有效性和安全性.方法 大量恶性心包积液的患者6例,置细管引流,在尽可能排出积液后,心包腔内给予恩度单药30mg,或联合PDD 20～40mg或Cab 150mg,封管和保留药物.3～5天后开放导管,若无液体流出,且B超检查证实无积液时,可以拔除导管;若心包内仍有积液,则需继续引流和重复以上药物治疗;最多用药3次.参照WHO制定的浆膜腔积液疗效评价标准及RECIST非靶病灶评价方法,评价客观疗效和毒副反应.结果 6例患者心包积液引流量平均为1500 ml,积液均呈暗红色浓血性;心包腔内注药共11次(平均1.8次/例),采用上述治疗后心包积液均得到控制,有效率达100%,同时心包填塞症状消失,一般情况明显改善.治疗期间无白细胞、血小板及血红蛋白下降等血液毒性反应,仅1例患者有轻度消化道反应.结论 在心包置细管引流的基础上,恩度单药或联合铂类药物灌注治疗恶性心包积液安全有效,能够改善患者的生活质量,延长生存,值得临床上进一步观察研究.%Objective To observe the efficacy and safety of recombinant human endostation injection (endostar), a new molecular targeted antitumor agent, alone or combine with the chemotherapy platinum agents ( cisplatin or carboplatin) for pericardial cavity infusion therapy on the malignant pericardial cavity effusion. Methods Six patients were diagnosed with serious malignant pericardial cavity effusion (5 cases with non-small cell lung cancer and 1 cases with malignant pleural mesothelioma) confirmed by histopathology or cytopathology. After pericardial cavity effusion was fully drainaged with central venous catheter, endostar 30 mg alone or combined with cisplatin 20-40 mg or carboplatin 150 mg were administrated into the pericardial cavity. Three to five days later, ff there was no effusion and confirmed with B ultrasonic examination, catheter may be removed. ff there was still some effusion, drainage and the drugs above should be applied again. Each patient treated at most 3 times. The efficacy was evaluated according to WHO criteria and RECIST criteria, toxicities were evaluated according to NCI CTC 3.0 version criteria. Results The average draught flow volume of pericardial effusion was 1500ml in 6 patients, which were dark red. Totally 11 times were completed and mean was 1.8 times. All the 6 patients achieved relieve of the pericardial cavity effusion(5 CR and 1 PR). The symptoms of the patients were better obviously.Only one patient had mild gastrointestinal side reaction. Conclusion Endostar combined with platinum agents has a very good efficacy on malignant pericardial cavity effusion. It is worthy of clinical generalization and further clinical observation.