الفهرس | يوجد فقط 14 صفحة متاحة للعرض العام |
المستخلص This study was designed to include forty selected patients suffering from malignant ascites whether primary or secondary. Group (I) included twenty patients with cytologically proven malignant ascites and were subjected to intraperitoneal chemotherapy. Group (II) included twenty patients with cytologically proven malignant ascites and were subjected to intraperitoneal chemohyperthermia. All patients were referred to the Tropical Medicine and Oncology Department, Kasr El-Aini Hospital, Cairo University from April 2004 to September 2005. The patients included 8 males and 32 females, their ages ranged between 43 and 68 years. They were subjected to complete clinical assessment, Laboratory work up including urine and stools analysis, complete blood pictures, liver function tests: including Serum bilirubin (total and direct), serum transaminases (ALT and AST), alkaline phosphatase, total proteins and albumin, prothrombin time and concentration, kidney function tests including serum urea and creatinine. Ultrasonography was done for all patients. Serum tumour markers including alpha-fetoprotein, CA19-9 and CA125 were done for all patients. Pathological examination of ascitic fluid before and after the session (1,2,3 and 4 weeks interval). Twenty patients were subjected to intraperitoneal chemotherapy (group I) and the other twenty patients who subjected to intraperitoneal chemohyperthermia (group II). The chemotherapeutic used was cisplatin 200 mg. The effect of intraperitoneal chemotherapy versus intraperitoneal chemohyperthermia was evaluated on the tumor histology, course of the disease and quality of life in patients with malignant ascites. There were improvement in quality of life in our patients after the procedures. This was indicated by the significant decrease in body weight and abdominal girth which reflect the regression of ascites in these patients. Patients experienced some relief of ascites related symptoms as shortness of breath, upper GIT symptoms, low back ache and fatigue. In both groups, there was a significant lowering of body weight and abdominal girth four weeks after the procedures. However the percent change in body weight and abdominal girth before vs. 4 weeks after the procedures was found significantly higher in group II than in group I. Considering ascitic fluid cytology the viable malignant cells were significantly decreased in both groups after four weeks of the procedures. In group I there was no significant difference in percentage of viable, necrotic or degenerative malignant cells before versus 4 weeks after the procedure. However, in those patients undergoing intraperitoneal chemohyperthermia (Group II) the effects were more pronounced. This was shown by the significant difference in the percentage of viable cells over the 4 weeks as well as the percentage of degenerative and necrotic cells in ascetic fluid cytology. At the end of the follow up period no significant difference as regard viability of malignant cells was observed in patients undergoing intraperitoneal chemotherapy (group I) than before the procedure. However the difference was still significant in those undergoing intraperitoneal chemohyperthermia. This was shown also by the percent change in viability of malignant cells before vs. 4 weeks after the procedures where it was significantly higher in group II than in group I. In the current study the adverse effects noted within the first 48 hours after the procedures were abdominal pain, anorexia, vomiting and constipation. Slight elevation of body temperature to 38° C was a significant finding in those undergoing intraperitoneal chemohyperthermia. Most side effects were relieved by the third day after the procedures. There was a significant impairment of renal function indicated by some elevation of serum creatinine in patients undergoing intraperitoneal chemotherapy. This effect was not pronounced in group II of our study. No significant adverse effects were noted on blood picture or other blood chemistry profiles in this work. |