Chest
Clinical InvestigationsLung CancerCombination Chemotherapy in Patients With Malignant Pleural Effusions From Non-small Cell Lung Cancer: Cisplatin, Ifosfamide, and Irinotecan With Recombinant Human Granulocyte Colony-Stimulating Factor Support
Section snippets
Materials and Methods
We analyzed 34 patients discovered to have histologically and/orcytologically proven malignant pleural effusion in the course ofdiagnosis of 118 patients entered in three consecutive clinical trialson advanced NSCLC. The protocols of the three trials are describedbelow. The first study, between May 1994 and June 1995, was a phase Istudy to determine the maximum tolerated dose of irinotecan combinedwith a fixed schedule of cisplatin and ifosfamide with rh, G-CSFsupport.4 Cisplatin, 20 mg/m2, and
Results
Patient characteristics are listed in Table 1. There were 18 men and 16 women, with a median age of 57 years (range, 43 to 72 years). All patients had adenocarcinoma. Twenty-two patientshad stage IV disease, and 12 patients had stage IIIB disease. The mostcommon sites for metastasis were the lung (11 patients), brain (7patients), and bone (6 patients). Five patients were asymptomatic atthe time of diagnosis. Fifteen patients presented with chest or backpain, 8 patients with dyspnea, and 6
Discussion
Malignant pleural effusions are a common presentation of NSCLC andcan reduce the quality of life. Most asymptomatic patients developincreasing pleural fluid that eventually evokes symptoms and requirespalliation. Therapeutic thoracentesis can provide temporary relief ofsymptoms but is associated with recurrence in a majority of patientswithin 1 to 3 days.9 The most common therapy for malignantpleural effusions is a chest tube drainage followed by intrapleuralinstillation of a sclerosing agent.
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