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胸腔灌注抗血管生成药物治疗恶性胸腔积液的研究进展
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Abstract:
恶性胸腔积液(malignant pleural effusion, MPE)是晚期癌症的常见及严重并发症，可不同程度地引起胸闷、胸痛、呼吸困难等不适症状，这对于晚期癌症患者无疑是雪上加霜。此外，恶性胸腔积液的存在会降低患者的整体表现状态，从而影响他们接受可能延长生命的抗癌治疗的可能性。以往，多以反复胸腔内置管引流为恶性胸腔积液的主要治疗手段，但单纯的胸腔内置管引流一方面无法解决胸腔积液反复产生的问题；另一方面因多次进行胸腔穿刺将不可避免地导致胸腔内感染、组织纤维化等并发症。目前，针对恶性胸腔积液的主要治疗方法是，对原发恶性肿瘤进行全面系统的全身化疗，同时针对胸腔积液做局部治疗，其中，胸腔内药物灌注治疗正进一步成为控制恶性胸腔积液产生的主要手段。经国内外多项研究证明，铂类药物、贝伐珠单抗、重组人血管内皮抑素等药物对恶性胸腔积液的产生有抑制作用。本文讨论两种抗血管生成药物(贝伐珠单抗、重组人血管内皮抑素)胸腔内灌注治疗(intrapleural perfusion therapy, IPT)恶性胸腔积液的疗效及其安全性。旨在为恶性胸腔积液治疗提供些许思路。
Malignant pleural effusion (MPE) is a common and serious complication of advanced cancer, which can cause chest tightness, chest pain, dyspnea and other discomfort symptoms to varying degrees, which is undoubtedly worse for patients with advanced cancer. In addition, the presence of malig-nant pleural effusion will reduce the overall performance of patients, thus affecting their possibility of receiving anti-cancer treatment that may prolong life. In the past, the main treatment method for malignant pleural effusion was to drain the pleural effusion repeatedly, but on the one hand, the simple drainage of pleural effusion could not solve the problem of repeated pleural effusion; On the other hand, multiple thoracentesis will inevitably lead to complications such as intrathoracic infec-tion and tissue fibrosis. At present, the main treatment methods for malignant pleural effusion are comprehensive and systematic systemic chemotherapy for primary malignant tumors, and local treatment for pleural effusion. Among them, intrathoracic drug infusion therapy is further becom-ing the main means to control the production of malignant pleural effusion. Many studies at home and abroad have proved that platinum drugs, bevacizumab, recombinant human endostatin and other drugs can inhibit the production of malignant pleural effusion. This article discusses the effi-cacy and safety of two anti angiogenic drugs (bevacizumab and recombinant human endostatin) in the treatment of malignant pleural effusion (IPT). It aims to provide some ideas for the treatment of malignant pleural effusion.
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