Chemical pleurodesis for malignant pleural effusions

Talc may be the most effective agent for chemical pleurodesis. However, insufflation has the disadvantages of the need for thoracoscopy and general anaesthesia. Doxycycline and minocycline seem to be effective in the small number of patients studied.

A systematic review including 43 studies with a total of 1,168 subjects with recurrent, symptomatic, malignant pleural effusions, was abstracted in DARE. The agents studied were doxycycline, minocycline, tetracycline, bleomycin, cisplatin, doxorubicin, etoposide, fluorouracil, interferon-beta, mitomycin-c, corynebacterium parvum, methylprednisolone, and talc. Only 4 agents (tetracycline, bleomycin, C parvum and talc) were studied in more than 100 patients.

The complete response rate after treatment with chemical pleurodesis was on average 64% (752/1169). The success rate of the pleurodesis agents was 0% with etoposide, 54% with bleomycin, 67% with tetracyclines, 76% with corynebacterium parvum, and 93% with talc. Pain (23%) and fever (19%) were the most commonly reported adverse effects.

Comment: The quality of evidence is downgraded by indirectness (there is a lack of direct comparability of the different agents) and sparse data.

Ədəbiyyat

1. Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med 1994 Jan 1;120(1):56-64.