SMALL CHEST-TUBE DRAINAGE FOLLOWED BY BLEOMYCIN SCLEROSIS FOR MALIGNANT PLEURAL EFFUSIONS

Objective: To review our experience with bleomycin sclerotherapy as tr eatment of pleural effusions due to gynecologic malignancies. Methods: Twenty-one women with histologically documented malignant effusions ( 16 ovarian carcinoma, three uterine sarcoma, and two cervical cancer) were treated with small flexible chest-tube drainage followed by intra pleural bleomycin sclerotherapy (60 units). Results: After placement o f the chest tube, suction was required for a median of 5 days (range 3 -12) before output was low enough (less than 100 mL/24 hours) to insti ll bleomycin. Among 24 treated effusions, there was a 71% overall resp onse rate, including ten complete responses (42%) and seven partial re sponses (29%); seven effusions (29%) did not respond to therapy. Six o f the seven patients whose effusions did not respond to bleomycin died of disease within 2 months of attempted sclerotherapy. Fever was the most common side effect, occurring in 13 of 21 patients (62%) followin g instillation of bleomycin. Pain during sclerosis was reported by onl y two patients. Conclusion: Bleomycin sclerotherapy after small flexib le chest-tube drainage of malignant pleural effusions is an effective technique, with minimal adverse reactions, for controlling effusions t hat develop in women with gynecologic malignancies.