Mitoxantrone for malignant pleural effusion due to metastatic sarcoma

Malignant pleural effusion due to metastatic sarcoma is a difficult problem to treat. Mitoxantrone hydrochloride is an anthracenodione that has been reported to be useful when used intracavitary for malignant effusion due to gynaecological malignancies. We reviewed 15 cases of malignant pleural effusion due to pleural involvement by metastatic sarcoma that were treated with intrapleural mitoxantrone. None of the patients had previous pleurodesis. A standard dose of 20 mg per square metre in 50 cc of saline solution was instilled by chest tube after drainage of the effusion. All patients were initially evaluated by chest CAT scans and chest films, control films were done immediately and 6 weeks after treatment. Thirteen cases were evaluated. Three patients presented with fever, two patients had local pain and one patient developed neutropenia. Three patients did not respond to the treatment. Complete resolution of the effusion was achieved in 76% of the patients: such an effect could be due to the local antineoplastic activity of the drug. We believe that mitoxantrone is effective in the treatment of malignant pleural effusion due to pleural involvement with sarcoma without causing significant local or systemic toxicity.