Malignant body fluid accumulation, mainly in the thoracic, abdominal and pericardial cavities, is a common complication of advanced malignancy and seriously affects the quality of survival of patients. The traditional solution is to repeatedly aspirate the effusion to reduce its occupying effect. In this way, instead, chest and peritoneal fluid is produced faster and more, and the final result will only cause patients to continuously lose a large amount of protein, electrolytes and other nutrients, which in turn leads to deterioration and death of patients, and the survival period is usually about 3-4 months, which has long troubled the majority of medical workers. Nowadays, a simple and easy method – body cavity circulation thermal perfusion chemotherapy – has solved this problem in clinical treatment of tumors.
The word “thermotherapy” originates from Greek, which originally means “high heat” or “overheating”. Ancient humans recognized the therapeutic effect of heat on diseases long ago. In 1800 B.C., an ancient Egyptian medical book states that “a man with a tumor in his chest was treated by me with a fire drill”. In ancient Chinese medicine, there is also a record of using garlic moxibustion to treat tumors.
In the late 1990s, with the continuous success and development of computer technology, the development and improvement of temperature measurement technology, and the development of cell molecular and biological research, the concept of “thermochemotherapy” has been gradually accepted by people and has gradually become another important tumor treatment after surgery, radiotherapy, chemotherapy and biological therapy. The concept of “thermochemotherapy” is gradually accepted by people, and gradually becomes another important treatment for tumors after surgery, radiotherapy, chemotherapy and biotherapy.
The concept of “thermotherapy” is gradually accepted as another important tumor treatment after surgery, radiotherapy, chemotherapy and biotherapy. It is defined as the treatment of malignant tumors by increasing the temperature of the whole body and/or tumor tissues (local) by various methods, using heat and its secondary effects.
Heat therapy alone or chemotherapy alone can kill tumor cells, but both have certain limitations, and both are difficult to kill tumor cells completely under the tolerance limit of the body. After years of exploration, it was found that the combination of thermal perfusion and chemotherapy was more effective and enabled many patients with refractory malignant pleural effusion, who were originally thought to be incurable, to have their disease controlled. Therefore, thermal perfusion chemotherapy has become another effective palliative therapy for the treatment of advanced cancer.
The mechanism of thermal perfusion chemotherapy is.
(1) High temperature (42℃~45℃) can induce apoptosis and necrosis. Tumor tissues are more sensitive to heat than normal tissues, and heating has a direct killing effect on cancer cells. Under the temperature above 42℃, with the extension of time (maintained for 50-60 minutes), the cell death rate increases exponentially, which has a significant inactivation effect on malignant tumors.
(2) Increase the drug concentration in local tumor tissues, and high concentration of chemotherapeutic drugs can overcome the drug resistance of tumor cells, so as to better play the anti-cancer effect.
(3) Heating can improve the sensitivity of tumor cells to certain chemotherapeutic drugs, while the permeability of cells is enhanced, and the microenvironment and pharmacokinetics of tumor cells are changed, which strengthens the effect of anticancer drugs. Warm liquid can increase the permeability of anticancer drugs with direct penetration depth up to 5mm, which can enhance the cytotoxic effect of chemotherapeutic drugs and induce apoptosis of tumor cells, and also prevent tumor recurrence and improve the survival rate of patients.
(4) The killing effect of combined application of heating and chemotherapy on cancer cells is significantly enhanced compared with the effect of heat therapy alone and chemotherapy alone.
Heat-infused chemotherapy makes the organic complementary effect of heat and chemotherapy-infused drugs and increases the sensitivity of patients to chemotherapy. It can kill malignant tumor cells more effectively, improve patients’ survival quality and prolong their lives, and at the same time reduce the side effects caused by radiotherapy and chemotherapy, which is therefore called “green therapy” by the international medical community.
According to the different ways of thermal perfusion, it can be divided into:
(1) Arterial interventional thermochemotherapy for advanced lung cancer, liver cancer, esophageal cancer, cervical cancer, etc.
(2) Intraperitoneal thermal perfusion chemotherapy for the treatment of abdominal and pelvic malignancies and combined cancerous peritoneal effusion.
(3) Intrathoracic thermal perfusion chemotherapy for the treatment of intrathoracic malignant tumors and combined cancerous pleural effusion.
(4) Intravesical thermal perfusion chemotherapy for advanced bladder cancer and postoperative recurrence.
Continuous body cavity thermal perfusion chemotherapy is generally favored because of its easy operation, less investment in equipment, certain efficacy and easy to promote application. It is to heat saline and chemotherapeutic drugs outside the body to 45℃, introduce them into the body cavity or blood vessel by using extracorporeal circulation pump, and continuously circulate them, and monitor the temperature in the outlet, inlet and body cavity by temperature measurement system to ensure that the temperature in the body cavity is maintained at 42℃～43℃ for a certain period of time (about 60 minutes) to keep the effective treatment temperature.
In order to give full play to the mechanism of heat killing; heat scavenging is performed on metastatic cancer cells widely planted on the plasma membrane, and chemotherapeutic drugs with heat-sensitizing effect are added according to the characteristics of cancer cell metabolic disorder and genetic material damage after heat therapy to induce cancer cells to stop dividing and apoptosis, eliminate the foci triggering malignant effusion, and enable rapid repair of biofilm to achieve the purpose of effective treatment of cancer effusion. Drugs such as glucocorticoids and interleukins are added to the treatment to prevent the occurrence of intestinal adhesions. Our clinical data showed that in 1530 cases of malignant thoracic and abdominal effusion, the effective control rate was 92.4% and the complete remission rate was 82%. The long-term effect is stable, and the survival is 76.8% for those with >6 months.
Indications.
1.Pleural effusion, peritoneal effusion, pericardial effusion caused by malignant tumor;
2.Thermal clearance treatment with surgical resection of gastric cancer, intestinal cancer, ovarian cancer and uterine body cancer;
3.Prevention of diffuse postoperative peritoneal metastasis treatment;
4.Radical treatment of malignant pleural mesothelioma;
5.Bladder cancer perfusion treatment, etc. It can also treat certain benign diseases such as: de-fibrotic treatment of tuberculous pleura and peritonitis, contouring treatment of purulent peritonitis and abscess pleura.
Contraindications.
1.Severe thoracoabdominal adhesions;
2.Patients with severe cachexia, cardiopulmonary insufficiency, implanted cardiac pacemaker and fever (38.5℃);
3.Patients with severe bleeding tendency, patients with severe liver and kidney failure, electrolyte disorders;
4.Patients with severe infection in the chest and abdominal cavity.