Therapeutic Effect And Mechanism Of Treating Malignant Pleural Effusions With Intrapleural Administration Of Cisplatin Bound To Activated Carbon Particles

Objective To evaluate the therapeutic effect and possible mechanism of treating malignant pleural effusions(MPE) with intrapleural administration of cisplatin bound to activated carbon particles.Methods (1) 60 hospitalized patients with MPE who had never been given intrapleural administration of drug were randomly divided into treating group (n=30)and control group(n=30). chest catheters were inserted percutaneously into the pleural space to drain the effusions .Cisplatin 40mg+lidocaine 100mg+activated carbon particles 1000mg for the treating group and the former same drugs except activated carbon particles for the control group were diluted in 80 mL saline solution and were then injected into pleural cavity through the chest catheters. Reaccumulation of fluid was detected by ultrasonic B every week . Whether above-mentioned treatment should be repeated was determined by ultrasonic B until up to four times . Curative effect,side-effect and Kamofsky scores a month later and survival time in 2 years were compared between two groups .(2) 20 patients,randomly selected from both groups respectively ,underwent whole body and chest SPECT scan to image lymphatic system by means of 99mTc-DX injected hypodermically at the web of toes after effusions drainage but before intrapleural injection of drug.Patients whose imaging graphics were abnormal would undergo the above SPECT again 2 weeks after intrapleural injection of drug so as to find changes in imaging graphics .Results (1) For the treatment group,complete response(CR) rate was 100% and that intrapleural injection needed only once in 25/30 patients,twice in 5/30 patients;for the control group,CR was seen in 2 cases which needed intrapleural injection twice,partial response (PR) was seen in 18 cases which needed intrapleural injection average 3.6 times,10 cases had no response,hence totle response rate(CR+PR) was 66.7%.There was significant statistical difference in curative effect between two groups( P < 0.01).Gastrointestinal upset and leucopenia were less and milder in treatment group than in control group(16.7% vs30.0% and 6.7%vs20.0% respectively),but there was no statistical difference between two groups(P >0.05).There were more patients with Kamofsky scores≥70 and less patients with Kamofsky scores <50 after treatment in treatment group than in control group(20 vs 12 and 3 vs 10 respectively, both P < 0.05) .There was no statistical difference in the number of the patients with Kamofsky scores 50～60 between two groups(7vs8).There was no statistical difference in the median survival time between two groups(10.5 months in treatment group vs 9.2 months in control group). (2) Improvement in lymphatic imaging was seen in 11/14(78.6%) cases of treatment group and 6/16(37.5%) cases of control group after treatment(p<0.05).Conclusion The treatment of malignant pleural effusions with intrapleural administration of cisplatin bound to activated carbon particles is extremely effective and safe and can improve lymphatic drainage as well.