| Objective:Malignant pleural effusion is one of the symptoms of advanced lung adenocarcinoma,seriously greatly affecting the quality of life of patients seriously.bevacizumab combined cisplatin injection in the chest is a relatively effective local treatment of malignant pleural effusion.however,the serious cytotoxicity of cisplatin and the expensive price of bevacizumab limits its clinical application.Our initial clinical work shows that the method of cavity injection with brucea javanice oil emulsion combined cisplatin has a good control of malignant pleural effusion and it improves the quality of patient’s life at a lower price.So,our study was to explore which one is better treatment of malignant pleural effusion between brucea javanice oil emulsion combined cisplatin and bevacizumab combined cisplatin in terms of clinical efficiency,side effects,quality of life and pharmac-oeconomics,and providing the clinical basis for the treatment of malignant pleur-al effusion with traditional Chinese medicine combined chemotherapy drugs.Method:Performed clinical retrospective studies on 43 malignant pleural effusion patients who were admitted by the oncology of the First Affiliated Hospital of Dalian Medical University during January 2011 to January 2015.There were a total of 24 cases for the brucea javanice oil emulsion group(brucea javanice oil emulsion + cisplatin),and,19 cases as bevacizumab group(bevacizumab + cisplatin).All the patients have been diagnosed as malignant effusion by cytology pathology.After draining the pleural fluid by thoracentesis,study subjects were given conventional chemotherapy comprising docetaxel : Docetaxel 75mg/m2,ivgtt,d1,q21d;for the brucea javanice oil emulsion group :cisplatin 75mg/m2,ic,points 2 times,d1,d3 and brucea javanice oil emulsion 80ml/time,ic,d1,d3;for the bevacizumab group:cisplatin 75mg/m2,ic,points 2 times,d1,d3 and bevacizumab 5mg/kg,ic,d1.Evaluate:1.short-term effect of malignant pleural effusion,involving objective response rate(ORR = CR + PR);2 long-term effect(overall survival,OS);3.incidence of adverse events;4 quality of life(KPS score,TCM clinical symptoms);5 Pharmacoeconomics match(cost-minimization analysis,CMA).Evaluation standard:the recent curative effect evaluation standard in accordance with the WHO;OS was calculated from Intrathoracic perfusion therapy for the first time from the beginning date of the patient follow-up to the end of time or the time of death;Based on adverse events(NCI-CTC)version 4.0 standards for evaluation;Quality of life using Karnofsky score and "Chinese medicine clinical research guidelines"(Trial,2002 version)in patients with malignant pleural effusion symptoms associated quantitative score;Pharmacoeconomic analysis based on the least cost.Using SPSS21.0 software for statistical analysis,P <0.05 statistically significant.Result:Before treatment,the two groups were balanced at baseline,with respect to gender,age stratification,pleural effusion site,presence of bloody pleural effusion,whether surgery,presence of distant organ metastasis,KPS was no significant difference(P> 0.05),Two groups of patients were comparable.1.Short-term effect: brucea oil javanice group(24 cases)and bevacizumab group(19 cases)of malignant pleural effusion ORR was 41.7%(10/24)and 52.6%(10/19)(P> 0.05).2.Long-term effect: no significant difference(P> 0.05)of median survival time(mOS)between the two group.3.Toxicity:incidence of grade 3-4 adverse effect of brucea javanice oil emulsion group and bevacizumab group were 4.2%(1/24)and 42.1%(8/19),the adverse effect rate in brucea javanice oil emulsion group which include fatigue,proteinuria,hypertension was lower than that in of bevacizumab group(P <0.05).4.Quality of life:KPS score improvement rate of brucea javanice oil emulsion group(91.7%,22/24)was better than bevacizumab group(63.2%,12/19);the improvement rate of TCM clinical symptoms brucea javanice oil emulsion group(75.0%,18/24)was better than bevacizumab group(42.1%,8/19),both of them were statistically significant(P <0.05).5.Pharmacoeconomics: brucea javanice oil emulsion group cost 1091.04 yuan per cycle,bevacizumab group cost 15600 yuan per cycle,in accordance with the principle of cost minimization,Java brucea fruit oil emulsion on pharmacoeconomics is better than that of bevacizumab group.Conclusion:Compared with bevacizumab combined cisplatin intrathoracic perfusion in treatment of malignant pleural effusion,brucea javanice oil emulsion combined cisplatin had the same effect,with a lower incidence of adverse reactions,higher quality of life,better economic advantages,therefore,is an economic and effective method for the treatment of malignant pleural effusion patients with lung adenocarcinoma. |
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