Herbal extract elemene intrathoracic injection in the treatment of lung cancer patients with malignant pleural effusion: a meta-anaylsis.

OBJECTIVE: The aim of this study was to evaluate the clinical efficacy of elemene intrapleural injection in the treatment of lung cancer with malignant pleural effusion by meta-analysis. MATERIALS AND METHODS: PubMed (1960-2014.4), EMBASE (1980-2014.4) and CNKI (1979-2014.4) data bases were searched to identify the randomized controlled trials about elemene intrapleural injection in the treatment of malignant pleural effusion caused by lung cancer. The relativel risk (RR) was used to evaluated the the clinical efficacy of elemene intrapleural injection in the treatment of pleural effusion compared to other drugs. RESULTS: A total of 1298 subjects with 14 studies were finally included in this meta-analysis. Meta-analysis showed that the objective response rate (ORR) in elemene group was much higher than that in other drugs group (RR =1.20, 95% CI:1.05-1.37, P = 0.008). We performed the sub-groups analysis according to the drugs used in the control group. And the subgroup analyzed demonstrated that the ORR in elemene group was higher than that in Cisplatin (DDP) and high sugar group with statistical difference (P < 0.05). But no statistical difference was found in the bleomycin and interleukin-2 [IL-2] subgroups (P > 0.05). CONCLUSION: High clinical efficacy of elemene was found in the treatment malignant pleural effusion in patients with lung cancer.

Recombinant human endostatin endostar suppresses angiogenesis and lymphangiogenesis of malignant pleural effusion in mice.

BACKGROUND: Malignant pleural effusion (MPE) is a common complication of lung cancer. One widely used treatment for MPE is Endostar, a recombined humanized endostatin based treatment. However, the mechanism of this treatment is still unclear. The aim of this study was to investigate the effects of Endostar in mice with MPE. METHODS AND MATERIALS: Lewis lung carcinoma (LLC) cell line expressing enhanced green fluorescent protein (EGFP) was injected into pleural cavity to establish MPE mice model. Mice were randomly divided into four groups. High dose of Endostar (30 mg/kg), low dose of Endostar (8 mg/kg), normal saline, or Bevacizumab (5 mg/kg) was respectively injected into pleural cavity three times with 3-day interval in each group. Transverse computed tomography (CT) was performed to observe pleural fluid formation 14 days after LLC cells injection. Mice were anesthetized and sacrificed 3 days after final administration. The volume of pleural effusion n was measured using 1 ml syringe. Micro blood vessel density (MVD), Lymphatic micro vessel density (LMVD), the expression level of vascular endothelial growth factor A (VEGF-A) and VEGF-C were observed by immunohistochemistry (IHC) staining. RESULTS: The volume of pleural effusion as well as the number of pleural tumor foci, MVD and the expression of VEGF-A were significantly reduced in high dose of Endostar treat group. More importantly, LMVD and the expression of VEGF-C were markedly lower in treat group than those in the other three control groups. CONCLUSION: Our work demonstrated that Endostar played an efficient anti-cancer role in MPE through its suppressive effect on angiogenesis and lymphangiogenesis, which provided a certain theoretical basis for the effectiveness of Endostar on the MPE treatment.

[A case of pulmonary carcinosarcoma with pleural effusion, progressive pleural thickening and a calcification-like lesion].

A 70-year-old man was admitted to our hospital with dyspnea. Chest X-ray film revealed right pleural effusion. Chest CT showed right pleural effusion with slight pleural thickening and a patchy calcification-like lesion. Adenocarcinoma cells were detected in pleural effusion, but upper gastrointestinal endoscopy, barium enema examination and ultrasonography of the abdomen failed to show the primary lesion. We made a diagnosis of primary adenocarcinoma of the lung. Chemotherapy was performed after pleurodesis. However there was gradual increase of right pleural thickening and expansion of the calcification-like lesions. The patient died 16 months after his first visit. Pathological findings of the autopsy specimen revealed the tumor composed of an adenocarcinomatous component and an osteosarcomatous component. The final diagnosis was primary carcinosarcoma of the lung.

Management of malignant pleural effusion associated with trapped lung syndrome.

Management of recurrent malignant pleural effusion associated with trapped lung syndrome remains problematic. An alternative treatment using a pleural catheter has been advocated. Between August 1999 and August 2002, 127 patients underwent thoracoscopy for malignant pleural effusion. Of these, 52 (41%) with trapped lung were managed by insertion of a pleural catheter. Mean age was 66 years (range, 42-89 years). The most frequent diagnosis was breast cancer. Spontaneous pleurodesis (drainage < 10 mL) occurred in 25 (48%) patients whose catheter was removed after 30 to 255 days (mean, 93.8 days). Symptomatic relief was achieved in 49 (94%) patients. Mean dyspnea score improved significantly from 3.0 to 1.9. Complications comprised catheter blockage, surgical emphysema, cellulitis, and loculated effusion in 2 patients each. Mean length of hospital stay was 3 days (range, 1-16 days). Median survival was 126 days (range, 10-175 days). We conclude that long-term placement of a pleural catheter provides effective palliation for malignant pleural effusion associated with trapped lung syndrome.

Long-term results of postoperative intrathoracic chemo-thermotherapy for lung cancer with pleural dissemination.

BACKGROUND: To overcome the poor prognosis of lung cancer with pleural dissemination, the authors developed postoperative intrathoracic chemo-thermotherapy (PICT). In this report, they present the long-term results for 31 consecutive patients who underwent resection, followed by PICT for lung cancer with pleural dissemination between April 1985 and December 1991. METHODS: Among the patients, there were 26 cases of adenocarcinoma, 3 cases of squamous cell carcinoma, and 1 case each of large and adenosquamous cell carcinoma. Twenty-four of these patients had an initial diagnosis of pleural involvement at thoracotomy. The other seven patients had massive malignant effusion at the time of the initial diagnosis. PICT was started between days 10 to 14 postoperatively. When possible, three courses of this procedure were administered at intervals of 5-7 days. RESULTS: The 5-year cumulative and 5-year local relapse-free survival rates were 24.6% and 76.3%, respectively. The 3-year and 5-year cumulative survival rates for 14 patients without mediastinal lymph node involvement were 68.4% and 42.7%, respectively. Those rates for 17 patients with mediastinal lymph node involvement were 22.7% and 0%, respectively. The 3-year survival rate in the former group was significantly better than that in the latter group. CONCLUSIONS: These results strongly suggest that in patients with pleural dissemination, PICT may be beneficial for regional disease control and improvement of survival, particularly for patients without mediastinal lymph node involvement.