Chemical pleurodesis for malignant pleural effusion

Abstract

Background and ObjectivesMalignant pleural effusion is a common complication of primary and metastatic pleural malignancies. It is usually managed by drainage and pleurodesis, but there is no consensus as to the best method of pleurodesis, this study was designed to compare the effectiveness, side effects, and cost of different chemical pleurodesis agents used in patients with malignant pleural effusion. MethodsSeventy-five patients with malignant pleural effusion were assigned into five groups each of 15 patients, Talc slurry 5gm, Tetracycline500mg, Bleomycin1IU/kg, Iodopovidone (2%) and patients underwent tube drainage only. Tube thoracotomy was performed in all patients and agents were administered through the chest tubes. ResultsTetracycline, talc slurry, iodopovidone andbleomycin, resulted inan insignificantly different success rates of 80%, 80%, 66.6%.73.3%, at 30days and, 66.6%, 73.3%, 60%, 66.6%, at 60days respectively while tube alone was much lower, 40% and 26.7% respectively. Chest tubes were removed after an average of 7.2±1.4days for tetracycline, 7±0.8days for talc slurry, 7.6±0.9days for iodopovidone and 6.4±1.5 days for bleomycin which did not differ significantly. Chest pain was more common in the tetracycline group, dyspnea was more common in the talc group, and fever was more common in the iodopovidone group. ConclusionSince tetracycline, talc slurry, iodopovidone, andbleomycin achieved comparable success rates in this study, we suggest that the drug availability and cost are important factors in choosing a sclerosing agent in developing countries.