Dipartimento di Specialita Medico-Chirurgiche, Universita degli Studi di Catania, Catania, Italy
Dipartimento di Specialita Medico-Chirurgiche, Universita degli Studi di Catania, Catania, Italy.
Eur Respir Rev. 2019 Jul 31;28(153). doi: 10.1183/16000617.0018-2019. Print 2019 Sep 30.
Debulking surgery and hyperthermic intrathoracic chemotherapy (HITHOC) has been successfully used in the treatment of thoracic tumours. Few authors report on the feasibility of its use in patients with lung cancer and malignant pleural effusion. The aim of this study was to evaluate the efficacy and results of debulking surgery and HITHOC in the treatment of selected patients with nonsmall cell lung cancer (NSCLC) and malignant pleural effusion.
A systematic review was conducted in MEDLINE in accordance with PRISMA guidelines. The word search included: "hyperthermic intrathoracic chemotherapy and/or HITHOC or hyperthermic intrapleural". Inclusion criteria were only those studies reporting a sufficient amount of data on HITHOC and surgery for lung cancer. Single case reports and review articles were excluded.
20 articles were selected as they related to the topic of HITHOC and lung cancer. Most were from China (n=8) and Japan (n=6). Only four out of the 20 articles had sufficient data for this review. In total, data for 21 patients were collected. Debulking surgery ranged from wedge resection to pneumonectomy and pleurectomy. Mean survival was 27 months and median survival was 18 months (range 1-74 months). 13 patients out of 21 (62%) were alive at 1 year and six (28.5%) were alive at 2 years. 10 patients were still alive at the time of the respective publication in the 21 patients included. Systemic toxicity and treatment-related mortality were nil. There were insufficient data to perform a meta-analysis.
Although reported survival in this systematic review is encouraging, available evidence concerning debulking surgery and HITHOC in N0-N1 NSCLC with malignant pleural effusion is weak. Better evidence in the form of a randomised controlled trial is mandatory.
减瘤手术和胸腔内热化疗（HITHOC）已成功用于治疗胸部肿瘤。少数作者报告了其在肺癌合并恶性胸腔积液患者中的应用可行性。本研究旨在评估减瘤手术和 HITHOC 治疗非小细胞肺癌（NSCLC）和恶性胸腔积液患者的疗效和结果。
根据 PRISMA 指南，在 MEDLINE 中进行系统评价。检索词包括：“胸腔内热化疗和/或 HITHOC 或高热胸腔内”。纳入标准仅为那些报告了足够数量的关于 HITHOC 和肺癌手术的数据的研究。排除了单病例报告和综述文章。
有 20 篇文章与 HITHOC 和肺癌相关，被选为研究对象。这些文章大多来自中国（n=8）和日本（n=6）。只有 4 篇文章有足够的数据用于本次综述。共收集了 21 例患者的数据。减瘤手术范围从楔形切除术到肺切除术和胸膜切除术。平均生存时间为 27 个月，中位生存时间为 18 个月（范围 1-74 个月）。21 例患者中，13 例（62%）在 1 年内存活，6 例（28.5%）在 2 年内存活。21 例患者中有 10 例在纳入时仍存活。全身毒性和治疗相关死亡率为零。由于缺乏数据，无法进行荟萃分析。
尽管本系统评价报告的生存率令人鼓舞，但关于 HITHOC 在 N0-N1 NSCLC 合并恶性胸腔积液中的减瘤手术的证据仍然薄弱。需要更好的证据形式，如随机对照试验。
