目的　用60 Coγ线和电子线混合照射治疗恶性肿瘤胸膜转移伴恶性胸水 ,观察患者对治疗的耐受性、急性毒副作用和疗效。方法　自 1996年 1月到 1998年 12月共治疗恶性胸水 5 5例。其中肺癌伴胸水49例 ,乳癌术后伴胸水 4例 ,恶性胸腺瘤术后伴胸水 2例。患者胸水被完全引流。60 Co野包括全胸膜腔 ,中央铅块屏蔽 ,屏蔽处照射电子束。用美国Multidata公司软件EXT 2 .4计算中平面胸膜受量 ,10 0 %等剂量线为2Gy ,常规照射 15次。可见肿瘤局部加量 2 0Gy/ 10次。患者同时接受 3～ 6个疗程化疗。用Kaplan Meier法计算胸水控制率和患者生存率。结果　治疗结束后胸水即时疗效表现为完全缓解 9例 ,部分缓解 46例。 6、12、18个月的胸水控制率和患者生存率分别为 76 %、5 3 %、44%和 6 4%、34%、2 6 %。中位胸水控制期为 14个月(范围为 2～ 32个月 )。中位生存期为 9个月 (范围为 4～ 32个月 )。治疗前后心、肝、肾功能未见异常。骨髓抑制是联合放、化疗的主要并发症。另有急性放射性食道炎 19例 (Ⅰ Ⅱ级 ) ,后期胸膜明显增厚伴纤维化 3例。未发生急性放射性肺炎。结论　60 Coγ线和电子线混合照射全胸膜腔 [30Gy/ (15次·3周 ) ]在临床上安全且具有较好的胸水控制疗效 Objective To treat the pleural metastasis of malignant pleural effusions with malignant pleural effusion by mixed irradiation of 60 Co γ ray and electron beam and to observe the patients’ tolerance to treatment, acute toxicities and side effects and curative effects. Methods From January 1996 to December 1998 a total of 55 cases of malignant pleural effusion were treated. There were 49 cases of lung cancer with pleural effusion, 4 cases of postoperative breast cancer with pleural effusion, and 2 cases of malignant thymoma with pleural effusion. Patients with pleural effusion is completely drained. The 60 Co field includes a full pleural cavity with a central lead block shield and a shielded electron beam. In the United States Multidata software EXT 2 .4 midplane pleural volume calculation, 100% isodose line 2Gy, conventional irradiation 15 times. Visible local tumor dose 20Gy / 10 times. Patients also receive 3 to 6 courses of chemotherapy. The Kaplan-Meier method was used to calculate the rate of pleural fluid control and patient survival. Results Immediate treatment of pleural effusion after treatment showed complete remission in 9 cases, partial relief in 46 cases. The rates of pleural fluid control and patient survival at 6, 12 and 18 months were 76%, 53%, 44% and 64%, 34% and 26%, respectively. Median pleural effusion control period of 14 months (range 2 to 32 months). The median survival was 9 months (range 4 to 32 months). Heart, liver and kidney function were normal before and after treatment. Myelosuppression is a major complication of combined radiotherapy and chemotherapy. Another acute esophagitis esophagitis in 19 cases (Ⅰ Ⅱ grade), pleural thickening with fibrosis in 3 cases. Acute radiation pneumonitis did not occur. Conclusion The combination of 60 Coγ line and electron beam irradiation in the whole pleural cavity [30 Gy / (15 times · 3 weeks)] is clinically safe and has good pleural effusion control efficacy