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Chemical pleurodesis for malignant pleural effusions
P B Walker-Renard1, L M Vaughan, S A Sahn
1College of Medicine, Medical University of South Carolina, Charleston.
Annals of Internal Medicine
|January 1, 1994
Summary
This review compares agents for chemical pleurodesis in malignant pleural effusion. Talc is most effective and least expensive, while doxycycline and minocycline show promise as tetracycline alternatives.
Area of Science:
- Pulmonology
- Oncology
- Pharmacology
Background:
- Malignant pleural effusion is a common complication of cancer.
- Chemical pleurodesis is a palliative treatment to prevent fluid reaccumulation.
Purpose of the Study:
- To review available agents for chemical pleurodesis in malignant pleural effusion.
- To compare the efficacy and toxicity of various chemical pleurodesis agents.
Main Methods:
- A comprehensive MEDLINE search (1966-1992) identified studies on chemical pleurodesis for malignant pleural effusion.
- Data on pleurodesis regimens, patient numbers, success rates, and adverse effects were extracted and analyzed.
Main Results:
- Chemical pleurodesis achieved a complete response in 64% of 1168 patients.
- Success rates varied widely, from 0% for etoposide to 93% for talc.
- Pain and fever were the most common adverse effects, reported in 23% and 19% of patients, respectively.
Conclusions:
- Talc demonstrated the highest efficacy (93%) and cost-effectiveness, despite requiring thoracoscopy.
- Doxycycline (72%) and minocycline (86%) show potential as effective tetracycline alternatives.
- Bleomycin is less effective and more expensive than talc and tetracyclines.
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