Ostrowski M J, Halsall G M
Cancer Treat Rep. 1982 Nov;66(11):1903-7.
The efficacy of intracavitary bleomycin in preventing the recurrence of malignant effusions following aspiration was assessed in a multicenter study. Of 200 patients treated, 158 were evaluated for response at 30 days. The overall response rate was 58%, with pleural effusions responding better (62%) than peritoneal effusions (47%). Pleural effusions resulting from primary breast tumors showed the best response (72%). No side effects were seen in 79.5% of the 200 patients. Pain and transient fever were reported in 21% of the patients after intraperitoneal instillation but in only 5% of those receiving intrapleural instillations. Nausea was experienced by 5.5% of the patients. There was no evidence of myelosuppression in any patient nor of enhancement of myelosuppression in the 57 patients receiving concurrent cytotoxic therapy. There was one possible treatment-related death in an elderly man given 120 mg of bleomycin intrapleurally. This leads us to recommend that the maximum dose should be 60 mg, especially as the response rate was not improved by doses greater than 60 mg. We conclude that bleomycin should be the agent of choice when the instillation of a cytotoxic agent following the drainage of a malignant effusion is indicated, since it is effective in preventing recurrence of the effusion, is generally free from systemic effects, and can be given to myelosuppressed patients or those already undergoing systemic cytotoxic therapy.
在一项多中心研究中，评估了腔内注射博来霉素在抽吸后预防恶性积液复发的疗效。在接受治疗的200例患者中，158例在30天时进行了反应评估。总体反应率为58%，胸腔积液的反应更好（62%），高于腹腔积液（47%）。原发性乳腺肿瘤引起的胸腔积液反应最佳（72%）。200例患者中有79.5%未出现副作用。21%的患者在腹腔内注射后报告有疼痛和短暂发热，但接受胸腔内注射的患者中只有5%出现此类情况。5.5%的患者有恶心症状。没有任何患者出现骨髓抑制的证据，接受同步细胞毒性治疗的57例患者也没有出现骨髓抑制加重的情况。有一名老年男性胸腔内注射120 mg博来霉素后可能与治疗相关死亡。这使我们建议最大剂量应为60 mg，特别是因为剂量大于60 mg时反应率并未提高。我们得出结论，当需要在恶性积液引流后注入细胞毒性药物时，博来霉素应作为首选药物，因为它在预防积液复发方面有效，通常无全身影响，并且可以给予骨髓抑制患者或已经在接受全身细胞毒性治疗的患者。
