Clinical Study

Combined Intrapleural and Intravenous Chemotherapy, and Pulmonary Irradiation, for Treatment of Patients with Lung Cancer Presenting with Malignant Pleural Effusion
A Pilot Study
Wu-Chou Su^a, Wu-Wei Lai^b, Helen H.W. Chen^c, Tzuen-Ren Hsiue^a, Cheng-Wen Chen^a, Wen-Tsung Huang^a, Tsai-Yun Chen^a, Chao-Jung Tsao^a, Nai-San Wang^d

Departments of
^aInternal Medicine,
^bSurgery, and
^cRadiation Oncology, and
^dCollege of Medicine, National Cheng Kung University, Tainan, Taiwan

Address of Corresponding Author

Oncology 2003;64:18-24 (DOI: 10.1159/000066516)

  Key Words

• Pleural effusion
• Intrapleural cisplatin
• Combined modality
• Non-small cell lung cancer

  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.

Copyright © 2003 S. Karger AG, Basel

  Author Contacts

Wu-Chou Su, MD, Division of Hematology/Oncology
Department of Internal Medicine, National Cheng Kung University Hospital
College of Medicine
138 Sheng-Li Road, Tainan, Taiwan 704 (ROC)
Tel. +886 6 235 3535, ext. 5401, Fax +886 6 276 6175, E-Mail sunnysu@mail.ncku.edu.tw

  Article Information

Number of Figures : 2, Number of Tables : 3, Number of References : 27