大剂量顺铂胸腔灌注联合多西紫杉醇静脉治疗NSCLC恶性胸腔积液的近期疗效及药代动力学研究  

Intrapleural Administration of Cisplatin to Treat Malignant Pleural Effusions in Patients with Non-Small Cell Lung Cancer: The Efficacy and Pharmacokinetics

作　　者：谢巍[1,2] 魏嘉旺 马筑[1,2] 卢冰[1,2] 欧阳伟炜[1,2] 苏胜发[1,2] 李青松[1,2] 王羽[1,2] 栗蕙芹[1,2] 胡银祥[1,2] 

机构地区：[1]贵阳医学院附属医院,贵州贵阳550004 [2]贵州省肿瘤医院,贵州贵阳550004 [3]江西赣州市肿瘤医院 [4]赣南医学院附属肿瘤医院,江西赣州341000

出　　处：《四川医学》2015年第6期783-787,共5页Sichuan Medical Journal

摘　　要：目的：评价顺铂胸腔灌注治疗非小细胞肺癌（ non-small cell lung cancer, NSCLC）恶性胸腔积液（ malignant pleural effusion,MPE）的疗效、毒副反应及其血浆中的药代动力学特点。方法 A组：40例合并MPE的NSCLC；B组：同时期内71例无MPE的NSCLC。 A组：多西紫杉醇65mg/m 2,静脉滴注、d 1；顺铂80mg/m 2,胸腔灌注、d 2；B组：多西紫杉醇用法与A组相同；顺铂（80mg/m 2）静脉滴注、d 2,21~28d/周期,治疗两周期后评价疗效。观察A组的胸腔积液控制情况及顺铂的药代动力学特点,并比较A、B两组的毒副反应及靶病灶（原发灶）的近期疗效。结果 A组胸腔积液的有效率82．5%,A、B组靶病灶的有效率分别为42．9%、40．8%,差异无统计学意义（=0．501,P=0．919）。 A组消化道反应较B组轻、Ⅱ~Ⅳ级反应为22．5%比对66．2%（=19．543,P=0．000）,肝、肾毒性相似；在血液学毒性方面,A组白细胞降低较B组轻、Ⅱ~Ⅳ级反应为52．1%比20．0%（=10．946,P=0．001）,血小板、血红蛋白毒性相似。 A组顺铂经胸腔灌注后血浆中总铂的代谢呈开放二室模型。结论顺铂胸腔灌注治疗NSCLC所致MPE的疗效好,铂的代谢呈开放二室模型；对胸腔积液以外病灶的疗效与静脉用药相似,但毒副反应减轻。Objective To evaluate the efficacy, toxicity, and pharmacokinetics of intrapleural administration of cisplatin to treat malignant pleural perfusions （ MPE） in Patients with Non-Small Cell Lung Cancer（ NSCLC） . Methods All the patients divided into two groups, group A and B. Forty NSCLC patients with MPE associated with NSCLC were enrolled in group A, a catheter was inserted into the pleural cavity, after complete drainage of the pleural effusion, Docetaxel （65mg/m 2 ） were adminis-tered by intravenous drip on day 1, Cisplatin （80mg/m 2 ） were administered via the catheter day 2. Seventy-one NSCLC patients without MPE were enrolled in group B, the administration of Docetaxel are the same as group A, and cisplatin （80mg/m 2 ） were administered by intravenous drip on day 2. Chemotherapy was administered every 21-28 days. Results In group A, the control rate （ CR＋PR） of MPE is 82. 5%. The response rate of target lesion （ primary tumor） was 42. 9% for Group A and 40. 8% for Group B （ =0. 501,P=0. 919）. Compared with Group A, Group B increased the severity of gastrointestinal （ =19. 543,P=0. 000） and leukocytic toxicities（ =10. 946,P=0. 001）. The acute toxicity of platelet, hemoglobin, kidney and liver was simi-lar between two groups. In Group A, the data of plasma concentrations of cisplatin were fitted a two-compartment open model ade-quately. Conclusions Intrapleural administration of cispaltin was an effective for patients with MPE due to NSCLC;intrapleural administration or intravenous drip of cispaltin had similar response rate for primary tumor, but intrapleural administration decreased the severity of acute toxity.

关 键 词：顺铂 非小细胞肺癌 恶性胸腔积液 药代动力学 

分 类 号：R734.2[医药卫生—肿瘤]