Combined Intrapleural and Intravenous Chemotherapy, and Pulmonary Irradiation, for Treatment of Patients with Lung Cancer Presenting with Malignant Pleural Effusion

Abstract

Objectives: Patients with non-small-cell lung cancer (NSCLC) and malignant pleural effusion (MPE) are difficult to manage clinically and have a short life expectancy. In this pilot study, we designed a protocol of combined intrapleural (i.p.) and intravenous (i.v.) chemotherapy and pulmonary irradiation to enhance local as well as systemic control of the disease. Methods: From April 1998 to April 2000, 27 patients with NSCLC and symptomatic MPE were eligible for the study. Patients received pre-radiation chemotherapy (cisplatin 60 mg/m² i.p. on day 1; gemcitabine 1,000 mg/m² i.v. on days 1, 8, and 15, q4week × 3) after surgical implantation of i.p. and i.v. port-A, followed by radiotherapy (7,020 cGy/39fr), and, finally, post-radiation chemotherapy (docetaxel 60 mg/m² q3week × 3–6 i.v.). Results: Grade 1/2 nausea/vomiting and impaired renal function were more common from pre-radiation than post-radiation chemotherapy; however, grade 3/4 toxicities from pre-radiation chemotherapy were minimal. Conversely, grade 3/4 leukopenia and grade 1/2 alopecia, diarrhea, elevation of SGOT/SGPT, and sensory impairment were more common following post-radiation chemotherapy. Only two patients experienced recurrence of pleural effusion. The overall response rate was 55% with 7% complete remission, 48% partial remission, 22% stable disease, and 22% progressive disease. The median failure-free and overall survival was 8 and 16 months, respectively. The one-year survival rate was 63% (95% confidence interval, 45–80%). Conclusions: We conclude that the combination of i.p. and i.v. chemotherapy and pulmonary irradiation is feasible and should be tested in a larger clinical trial to determine whether survival can be improved for this cohort of patients.

Prognostic value of soluble H7-B4 in pleural effusion associated with lung cancer

“…The present standard treatment is evacuation of the pleural fluid followed by intravenous or intrapleural chemotherapy [7]. However, it was found that not all patients were benefited from the chemotherapy, especially in patient with short overall survival time.…”

Angiogenetic biomarkers in non-small cell lung cancer with malignant pleural effusion: Correlations with patient survival and pleural effusion control

“…For NSCLC patients with MPE, the goals of treatment are to prolong survival and control the volume of pleural effusion [17][18][19]. We had hoped to find some biological predictors of incipient MPE so that we could use agents to block it.…”

Novel Intrapleural Therapies for Malignant Diseases

“…Su et al [17] reported a more extensive combination therapy approach wherein 27 patients with MPE secondary to bronchogenic carcinoma received sequential treatment with IP cisplatin followed by intravenous gemcitabine, thoracic irradiation, and intravenous docetaxel. The overall response rate was 55% with 7% CR.…”

“…The overall response rate was 55% with 7% CR. Remarkably, only 2 of 27 patients experienced recurrence of pleural effusion, and the 1-year survival was 63% [17]. To ascertain whether IP chemotherapy actually had an effect on malignant cells in the pleural space, Matsuzaki et al [18] resected primary pulmonary adenocarcinoma in 11 consecutive patients with pleural dissemination and subsequently treated them with IP cisplatin.…”