胸腔灌注重组人p53腺病毒联合顺铂等治疗肺癌胸腔积液

Perfusion treatment with .recombinant adenoviral - mediated p53 gene transfer and cisplatin through an intrapleural catheter for lung cancer with malignant pleural effusion

目的评价胸腔置管灌注重组人p53腺病毒（rAd／p53）联合顺铂等治疗肺癌恶性胸腔积液的疗效和安全性。方法38例肺癌恶性胸腔积液患者，胸腔置管灌注1×10^12VP，每周1次，48～72h内则序贯应用顺铂注射液80mg或5-氟尿嘧啶1．5g或表柔比星60mg，每周1种／1次。结果38例患者中完全缓解16例（42．1％），部分缓解18例（47．4％），无效4例（10．5％），总有效率89．5％。主要不良反应为寒战发热76．3％（29／38）、胸痛55．3％（21／38）、恶心呕吐68．4％（26／38），均可耐受。生活质量karnofsky评分，提高20分以上者23例（60．5％），提高10-20分7例（18．4％）。结论rAd／p53注射液联合顺铂等治疗肺癌恶性胸腔积液疗效较好，无明显不良反应，对患者的生活质量有较好改善。

Objective To evaluate the therapeutic effects and adverse reactions of recombinant adenoviral - mediated 1353 gene transfer（ rAd/p53 ） combined with cisplatin and so all in the treatment of lung cancer with malignant pleural effusion. Methods Thirty - eight lung cancer patients with malignant pleural effusion, were infused intrapleurally with rAd/p53 at a dose of 1 ×10^12VP every time through an intrapleural catheter, one time a week, then cisplatin 80 mg or 5 - fluorouracil 1.5 g or epidoxorubcin 60 mg by sequence in 48 - 72 hours, one kind and one time a week. Results Among the 38 cases, 16 completely recovered（42.1% ）, 18 partial recovered（47.4% ）, and 4 coases no changed（ 10.5% ）. The overall effective rate was 89.5%. The major adverse effects were fever in 29 cases （76.3%）and chest pain in 21 cases （55.3%） and nausea or vomit in 26 cases（68.4% ）. Life quality for the patients was improved after treatment. The Karnofsky score rose by over 20% in 23 cases（60.5% ） and 10% - 20% in 7 cases（ 18.4% ）. Conclusions rAd/p53 transfer combined with cisplatin and so all is effective and safe for the control of lung cancer with malignant pleural effusion. The life quality for the patients was improved.