PLEURODESIS IN MALIGNANT PLEURAL EFFUSIONS - A RANDOMIZED STUDY OF TETRACYCLINE VERSUS BLEOMYCIN

Malignant pleural effusions are commonly managed with tube thoracostom y drainage followed by chemical pleurodesis. Both tetracycline and ble omycin have been shown to be effective for intrapleural instillation, although neither agent has definitively proved advantages over the oth er. The aim of the present study was to compare these two agents in te rms of response rate and toxicity profile. A prospective, randomized t rial was carried out in a single centre. Between May 1993 and January 1996, 62 evaluable patients with proved malignant pleural effusion wer e allocated to receive either intrapleural tetracycline (1.5 g) or ble omycin (60 mg) after the same drainage procedure, Demographic, clinica l and fluid parameter data were comparable in both groups. Response wa s evaluated at 1, 3 and 6 months after pleurodesis. Mean survival and time to relapse did not differ between the two groups. No statisticall y significant differences were found in terms of efficacy at each eval uation time. Overall, 16 (52%) and 20 (64%) patients had a recurrence of pleural effusion during follow-up in the tetracycline and bleomycin arms, respectively. Fever was most common in bleomycin-treated patien ts (p=0.024) while pain was most frequent in the tetracycline arm (non significant). Since no study agent was superior to the other in this t rial, we suggest that economic costs, drug availability and medical sk ill should be considered in the choice of a sclerosing agent.