Patients with cancer combined with malignant ascites are usually in an advanced stage with an expectation of survival of about a few weeks or months. The one-year survival rate is less than 10%. Nevertheless, the appropriate treatment of malignant ascites is important to improve the quality of patient survival. Treatment of malignant ascites is mostly palliative and decompensative. Intraperitoneal administration increases the concentration and duration of action of drugs, improves the therapeutic effect and reduces systemic adverse effects. In principle, anti-cancer drugs and biological agents used for the treatment of malignant pleural effusion can also be used for the treatment of malignant ascites, and the dose should be increased accordingly than the treatment of malignant pleural effusion. 1.Single drug: (1) Cisplatin: Cisplatin is not easy to cross the peritoneal barrier after intraperitoneal injection, and the clearance is slow, so the intraperitoneal drug concentration and action time are much higher than the plasma concentration. Cisplatin can directly contact with tumor cells, penetrate into tumor cells and bind with DNA to kill tumor cells. Since the depth of cisplatin on the tumor surface is only 0.1-0.2cm, it is more effective for small tumors in the abdominal cavity or small residual tumors with ascites after surgery, but less effective for huge tumors in the abdominal cavity with ascites. Usage: Dissolve cisplatin
60~100mg/m2 in 500ml of saline, add 10mg of dexamethasone and 20ml of 2% lidocaine, and connect the infuser into the abdominal cavity. The patient was instructed to change position to facilitate uniform distribution of the drug. On the day of drug administration and the next day, hydration, diuretic and antiemetic treatment were given. 2-3 weeks were repeated and the efficiency was
60% to 80%. (2) Carboplatin: It is the second generation platinum compound, and its anticancer activity and tumor spectrum are comparable to cisplatin, but the side effects are lighter, so it can be used in the abdominal cavity instead of cisplatin, and the dosage of carboplatin is generally 400-500mg/time, without hydration, and the efficiency is 60%-90%. (1) Combination of cisplatin and fluorouracil: Cisplatin is a cell cycle non-specific drug, which mainly kills proliferating cells and prompts some G0-phase cells to enter the proliferating phase, and the combination with fluorouracil, a cell cycle-specific drug, can improve the killing effect. In addition, ascites is mostly caused by adenocarcinoma metastasis, and fluorouracil has better efficacy against adenocarcinoma. Therefore, the combination of the two drugs can bring out the maximum anti-cancer effect. Usage: Cisplatin
100mg dissolved in 200ml of saline for intraperitoneal instillation, followed by 500-750mg of fluorouracil plus 500ml of saline for 8 hours for slow intraperitoneal instillation. The efficiency of the combined drug group was reported to be
92.9% and 60.0% in the group with cisplatin alone, with significant differences. (2) Combination of cisplatin and pegylated glycosides: Experiment and clinical have shown that cisplatin and pegylated glycosides have obvious synergistic effect. The dosage is 50mg of cisplatin and 100mg of pedipalpine dissolved in 500ml of saline and injected into the peritoneal cavity, with routine postoperative hydration, diuresis and antiemetic. Once a week for 3 to 4 times. The effectiveness rate is about 75%. (3) Carboplatin in combination with fluorouracil: The mechanism of action and usage are the same as that of cisplatin and fluorouracil. Dosage: Carboplatin 500mg, fluorouracil 500-750mg, without hydration. The efficiency is about 90%. 3. Biological agents: (1) Interleukin-2: Intraperitoneal application can increase the drug concentration and significantly enhance the activity of immune cells in the peritoneal cavity, thus improving the anti-tumor effect. Usage: Dissolve 200,000~300,000 units of interleukin-2 in 60ml of saline.
The drug is dissolved in 60 ml of saline and slowly injected into the peritoneal cavity, while dexamethasone 10 mg is applied in the peritoneal cavity once or twice a week for 3 weeks. The main side effects are transient chills and fever, which can be treated symptomatically. (2) Tumor necrosis factor: The mechanism of action is to directly kill tumor cells, activate immune response against tumor, mediate inflammatory response and reduce tissue fluid exudation. The general dosage is 1 million units/m2, 1~2 times a week. The side effects are fever and chills, which are relieved by symptomatic treatment.