CHEMICAL PLEURODESIS FOR MALIGNANT PLEURAL EFFUSIONS

Purpose: To provide information about available agents for chemical pl eurodesis. Data Sources: A MEDLINE search (1966 to October 1992) was c onducted using the terms malignant pleural effusion and pleurodesis. S tudy Selection: All articles containing references to patients with re current, symptomatic, malignant pleural effusions treated with chemica l pleurodesis were selected and reviewed for pleurodesis regimen, numb er of patients treated, success rate (complete response), and adverse effects. The agents studied included doxycycline, minocycline, tetracy cline, bleomycin, cisplatin, doxorubicin, etoposide, fluorouracil, int erferon-beta, mitomycin-c, Corynebacterium parvum, methylprednisolone, and talc. Data Extraction: Independent extraction by three observers. Results: Studies including a total of 1168 patients with malignant pl eural effusions were reviewed for efficacy of the pleurodesis agent an d studies including 1140 patients were reviewed for toxicity. Chemical pleurodesis produced a complete response in 752 (64%) of 1168 patient s. The success rate of the pleurodesis agents varied from 0% with etop oside to 93% with talc. Corynebacterium parvum, the tetracyclines, and bleomycin had success rates of 76%, 67%, and 54%, respectively. The m ost commonly reported adverse effects were pain.(265 of 1140, 23%) and fever (220 of 1140,19%). Conclusions: Doxycycline and minocycline, wi th success rates of 72% and 86%, respectively, appear to be effective tetracycline-replacement agents in the few patients studied. Talc appe ars to be the most effective and least expensive agent; however, insuf flation has the disadvantages of the expense of thoracoscopy and the u sual need for general anesthesia. Bleomycin appears to be less effecti ve than talc and the tetracyclines and is substantially more expensive .