Qian Li¹  WenkuiSun²  Dongmei Yuan²  Tangfeng Lv²  Jie Yin²  Ehong Cao²  Xinwu Xiao²  Yong Song³

 ¹Nanjing, China Jinling Hospital, School of Medicine Department of Respiratory and Critical Care Medicine ²Nanjing, China Jinling Hospital, School of Medicine, Nanjing University Department of

Respiratory and Critical Care Medicine ³Nanjing, China Jinling Hospital, School of Medicine, Nanjing University, Department of Respiratory Medicine

Objective：Malignantpleuraleffusion (MPE) is mainly caused by metastatic pleuralcancer and definesmalignant tumors with apoor prognosis. To achieve sufficient control of MPE andto minimize invasive interventions are the primarygoals of the treatingphysicians. Recombinant human mutant tumor necrosisfactor-alpha (rhu-TNF) hasbeen used in the treatment of MPE. The aim of our researchstudy, which includeda total of 102 patients with MPE caused by lung cancer, was retrospectivelytoevaluate efficacy and safety of rhu-TNF application viaultrasound-guidedchest tube for the treatment of MPE. Rhu-TNF was administered as a single doseto 102 patients, and dexamethasone (Dmx, 5mg) was administered 30 min beforerhu-TNF in 35 patients inorder to prevent side effects. The primary endpoint wasthe efficacy of the Rhu-TNF treatment (disease response rate) and sideeffects(pain, fever and flu-like symptoms) evaluated four weeks afterinstillation. Thedisease response rate of Rhu-TNFtreatment in 102 patients was 81.37%. Side effectsincluded 13 (12.75%) patients complaining about flu-like symptoms, 15 (14.71%)with fever/chill, and 14 (13.73%) with chest pain. Asignificantly higherefficacy was observed for the treatment with three versus two millionunitsrhu-TNF (=0.036), while the adverse effects were similar. Although applicationof Dmx before the intra-pleural instillation of rhu-TNF reduced theincidence ofadverse events, no significant differences were found. Inconclusion, our studyshows that intra-pleural instillation of rhu-TNF in MPE patients achievessufficient control of MPE and minimizes invasive interventions. Method：Malignantpleurale ffusion (MPE) is mainly caused by metastatic pleuralcancer and definesmalignant tumors with apoor prognosis. To achieve sufficient control of MPE andto minimize invasive interventions are the primary goals of the treatingphysicians. Recombinant human mutant tumor necrosisfactor-alpha (rhu-TNF) hasbeen used in the treatment of MPE. The aim of our researchstudy, which includeda total of 102 patients with MPE caused by lung cancer, was retrospectively toevaluate efficacy and safety of rhu-TNF application via ultrasound-guided chesttube for the treatment of MPE. Rhu-TNF was administered as a single dose to 102patients, and dexamethasone (Dmx, 5mg) was administered 30 min before rhu-TNFin 35 patients inorder to prevent side effects. The primary endpoint was theefficacy of the Rhu-TNF treatment (disease response rate) and side effects(pain, fever and flu-like symptoms) evaluated four weeks after instillation.The disease response rate of Rhu-TNFtreatment in 102 patients was 81.37%. Sideeffects included 13(12.75%) patients complaining about flu-like symptoms, 15(14.71%)with fever/chill, and 14(13.73%) with chest pain. Asignificantly higherefficacy was observed for the treatment with three versus two millionunitsrhu-TNF (=0.036), while the adverse effects were similar. Although applicationof Dmx before the intra-pleural instillation of rhu-TNF reduced theincidence ofadverse events, no significant differences were found. Inconclusion, our studyshows that intra-pleural instillation of rhu-TNF in MPE patients achievessufficient control of MPE and minimizes invasive interventions. Result：Malignantpleural effusion (MPE) is mainly caused by metastatic pleural cancer anddefines malignant tumors with apoor prognosis. To achieve sufficient control ofMPE and to minimize invasive interventions are the primary goals of thetreating physicians. Recombinant human mutant tumor necrosisfactor-alpha(rhu-TNF) has been used in the treatment of MPE. The aim of our research study,which included a total of 102 patients with MPE caused by lung cancer, wasretrospectively to evaluate efficacy and safety of rhu-TNF applicationviaultrasound-guided chest tube for the treatment of MPE. Rhu-TNF wasadministered as a single dose to 102 patients, and dexamethasone (Dmx, 5mg) wasadministered 30 min before rhu-TNF in 35 patients inorder to prevent sideeffects. The primary endpoint was the efficacy of the Rhu-TNF treatment(disease response rate) and sideeffects (pain, fever and flu-like symptoms)evaluated four weeks afterinstillation. The disease response rate ofRhu-TNFtreatment in 102 patients was 81.37%.Side effects included 13 (12.75%)patients complaining about flu-like symptoms, 15 (14.71%) with fever/chill, and14 (13.73%) with chest pain. Asignificantly higher efficacy was observed forthe treatment with three versus two millionunits rhu-TNF (=0.036), while theadverse effects were similar. Although application of Dmx before theintra-pleural instillation of rhu-TNF reduced theincidenceof adverse events, nosignificant differences were found. Inconclusion, our study shows thatintra-pleural instillation of rhu-TNF in MPE patientsachieves sufficientcontrol of MPE and minimizes invasive interventions. Conclusion：Malignantpleuraleffusion (MPE) is mainly caused by metastatic pleuralcancer and definesmalignant tumors with apoor prognosis. To achievesufficient control of MPEandto minimize invasive interventions are the primarygoals of the treatingphysicians. Recombinant human mutant tumor necrosisfactor-alpha (rhu-TNF) hasbeen used in the treatment of MPE. The aim of our research study, whichincluded a total of 102 patients with MPE caused by lung cancer, wasretrospectively to evaluate efficacy and safety of rhu-TNF applicationviaultrasound-guided chest tube for the treatment of MPE. Rhu-TNF wasadministered as a single dose to 102 patients, and dexamethasone (Dmx, 5mg) wasadministered 30 min before rhu-TNF in 35 patients inorder to prevent sideeffects. The primary endpoint was the efficacy of the Rhu-TNF treatment(disease response rate) and sideeffects (pain, fever and flu-like symptoms)evaluated four weeks afterinstillation. The disease response rate of Rhu-TNF treatmentin 102 patients was 81.37%. Side effects included 13(12.75%) patientscomplaining about flu-like symptoms, 15(14.71%) with fever/chill, and14(13.73%) with chest pain. Asignificantly higher efficacy was observed for thetreatment with three versus two millionunits rhu-TNF (=0.036), while theadverse effects were similar. Although application of Dmx before theintra-pleural instillation of rhu-TNF reduced theincidence of adverse events, nosignificant differences were found. Inconclusion, our study shows thatintra-pleural instillation of rhu-TNF in MPE patientsachieves sufficientcontrol of MPE and minimizes invasive interventions.

Keywords：Malignant pleuraleffusion  Lung cancer