CURRENT TREATMENT STRATEGIES IN MALIGNANT PLEURAL EFFUSIONS

Malignant pleural effusions are a grave consequence of advanced cancer disease. The successful suppression of pleural fluid reaccumulation c an make a major contribution to the management and palliative care of patients with disseminated cancer. Many treatment concepts have been r eported in the literature. The recommended therapy in malignant pleura l effusions consists of intrapleural instillation of a sclerotic agent to produce pleurodesis. Different substances have been used, includin g tetracyclines, cytostatic agents, fibrin, talc, Corynebacterium parv um, cytokines and others. We reviewed the most frequently used techniq ues of pleurodesis in order to define the most effective treatment con cept. In 15 prospective randomized trials the success rates varied fro m 13% with bleomycin to 100% with talc or Corynebacterium parvum. Talc was superior to other agents in 6 of 6, Corynebacterium parvum in 3 o f 4 and bleomycin or tetracycline only in 3 of 8 studies. Adverse effe cts were frequently observed with cytostatic agents, but were very rar e in the case of talc or fibrin instillation. Comparing the recently p ublished data pleurodesis with talc appears to be the most effective t reatment strategy, followed by Corynebacterium parvum, bleomycin and t etracycline.