Feasibility And Short Term Clinical Efficacy Of B Ultrasound-guided Continuous Circulatory Intrapleural Perfusion Hyperthermia For The Treatment Of Malignant Pleural Effusion

Background and objective：Malignant pleural effusion (MPE) is one of the most common complications ofmalignant turmor. Despite extensive clinical research, no effective therapy foradvanced malignant pleural mesothelioma has been established. Previous treatment ofMPE includes indwelling pleural catheter placement, pleurodesis, intrapleural localchemotherapy, intrapleural immune therapy. These methods, used alone or in joint,that efficacy varies in different reports. With the development of hyperthermicperfusion treatment in recent years, hyperthermic intraperitoneal perfusion treatmentsystem used in the abdominal cavity to treat the intra-abdominal implantationmetastasis and peritoneal effusions has achieved great success. But there is still nosystemic investigate and report on continuous circulatory intrapleural perfusion ofhyperthermia (CCIPH) treated IPH both domestic and international.And the mostoptimal tempreture has not concensus. Under the premise of not damaging normaltissue, the higher the temperature of perfusion, the more thorough of the tumor cellkilling effect. This paper mainly discusses the feasibility and clinical effect of CCIPHon the treatment of MPE. As well as evaluats the short-term effect and side effectsbetween the two perfusion temperature of45℃and48℃.Contents and Methods：During March2011through March2012, CCIPH was carried out in13patients withcarcinoma complicated by MPE. Pleural effusion was proved by chestroentgenogram studies or computed tomography in all patients, and pleurocentesiswas performed before CCIPH. Malignant cell was found in the Pleural effusion of allof the patients. Tow tubes for irrigation inlet and outlet, which were inserted into thepleural cavity under the positioning of B ultrasound, were connected to hyperthermicintraperitoneal perfusion treatment system. CCIPH was carried out under localanesthesia. The thoracic cavity was irrigated for90min with48/45℃distilled water (about2,500-3,500ml),a flow rate of300-400ml/min. CCIPH was carried out for2or3times, with a interval of48h. The efficacy was evaluated4weeks after theCCIPH, and was long term followed-up.Results：1. All13patients successfully completed this treatment without treatment failure orinterruption of the therapy.2. The control rate of both48℃and45℃of pleural effusion was100%withoutstatistic differents. The KPS was improved more than10scores of all the cases.3. All of the cases had the side effects such as sweating, hot flashes, fever, increasedheart rate and so on, which could be tolerated.And after the treatment all the indexrecovered to basic level did not need special treatment.4. One case of the48℃perfusion group suffered from reexpansion pulmonaryedema,which was cured after oxygen inhalation, intravenious adrenal corticalhormone, diuretics and maintaining hemodynamic stability.Conclusions：1. This less invasive modality seems to offer a safe, feasible and excellent localcontrol for MPE.2. There was no defferent in short term effect and side effects between48℃and45℃group.