Bleomycin in the treatment of 50 cases with malignant pleural effusion

Patients with symptomatic malignant pleural effusion (MPE) may gain profit from pleurodesis for relief of dyspnea and in preventing the accumulation of fluid or air in the pleural space. Pleurodesis methods are palliative and regard the patient's symptoms and underlying disease condition that are different. The purpose of this study was to assess the efficacy of bleomycin in the treatment of malignant pleural effusion.

From March 2003 to August 2009, 50 cases of malignant pleural effusion referred for chemical pleurodesis. Malignant pleural effusion was diagnosed by cytotogical examination of pleural fluid after thoracosynthesis. Pleurodesis was done by pleural fluid instillation of bleomycin. The severity of effusion with response to treatment was compared.

Nineteen (38%) cases were males and 31 (62%) were females. The mean age of these patients was 60.3±15.8 years (range=31 to 85 years). The majority of patients had breast cancer and lung adenocarcinoma. The mean volume of pleural fluid drained was 2282±848.69(cc) (range 800-4500 (cc)). Pleural effusion was mild in 2 (4%) patients, moderate in 25 (50%) and severe in 23 (46%). There was no statistically significant difference between the response to treatment and the amount of effusion (p=.087). Complete response was seen in 33 (66%) patients, partial response in 11 (22%) and failure to treatment in 6 (12%). There was no relationship between the response to treatment and tumor type. There was not any complication in 33 (66%) patients, but fever was seen in 2 (4%) and chest pain in 7 (14%) and both of them in 8 (16%).

The results show that pleurodesis with bleomycin has improved the symptoms of 88 percent of patients without causing any significant complications. Although pleurodesis does not have any effect on patients' survival, it has positive impact on their lives continuously by enhancing the quality of life.