Background: To study the effect and complications of combined 60Co γ ray and electron beam irradiation to malignant pleural effusion.
Methods: From January,1996 to December,1998,55 patients with malignant pleural effusion (unilateral; 49 cases of primary lung cancer,4 breast cancer and 2 thymic tumor) received whole pleural cavity irradiation of 60Co γ ray with centrally placed lead blocks to protect the vital organs and normal lung tissue,and the electron beam irradiation at the area which was covered by lead blocks in 60Co γ ray irradiation.The pleural effusion was completely drained before radiotherapy,and dose distribution of middle level was calculated by TPS using EXT 2.4 version software (Multidata Co.USA).The 100% isodose curve was 2Gy,15 fractions were given and another 20Gy/10Fx irradiation was added to the visible tumor.All patients received sequential chemotherapy for 3-6 cycles (cisplatin-based regimens for lung cancer and thymic tumor,cyclophosphamide and adriamycin and fluoracil for breast cancer).Kaplan-Meier curve was used to evaluate the pleural effusion control rate and survival rate of patients.
Results: Complete remission of the malignant pleural effusion was seen in 9 patients and partial in 46 when treatment completed.The 6-,12-,18-month pleural effusion control rate and survival rate of the patients were 76%,53%,44% and 64%,34%,26%,respectively.The median control time of effusion and survival time were 14 months (2-32 months) and 9 months (4-32 months) respectively.We did not find any abnormality in liver function as well as in kidney function before and after treatment.Myelosuppression was the main side effect after combined chemotherapy and radiotherapy.Nineteen patients suffered from acute oesophagitis in grade 1-2,and 3 serious pleural fibrosis.There was no acute irradiation pneumonitis.
Conclusions: The treatment for malignant pleural effusion with combined 60Co γ ray and electron beam irradiation is tolerable and effective in clinical use.