Comparison of the effectiveness of some pleural sclerosing agents used forcontrol of effusions in malignant pleural mesothelioma: A review of 117 cases

Background and Objectives: Management of malignant pleural mesothelioma (MP M) has been an important clinical issue regardless of the treatment modalit y employed. We aimed to investigate the efficacy of oxytetracycline (OT), C orynebacterium parvum (CP), and nitrogen mustard (NM) in the management of pleural effusion associated with MPM. Methods: One hundred and seventeen pa tients who had stage-2 MPM or over according to the Butchart staging system and unilateral or bilateral pleural effusion took part in the study. The p atients received either OT (35 mg/kg), CP (7 mg), or NM (0.4 mg/ kg) throug h a chest tube for pleurodesis. The association between several clinical pa rameters and patient survival was also investigated. Results: OT was applie d to 59, CP to 29 and NM to 29 cases. A statistical analysis of the results obtained by these agents have demonstrated that OT (30 days, 81%; 90 days, 76.2%) and CP (30 days, 86.2%; 90 days, 79.3%) led to a significantly high er rate of successful pleurodesis as compared to NM (30 days, 48.2%; 90 day s, 41.3%; p <0.05). Although the procedure was generally well tolerated by the patients, the NM-treated group experienced significantly more nausea-vo miting (46.1%) and hypotension (35.8%) compared to patients who received OT (nausea-vomiting and hypotension 4.3%; p < 0.001) and CP (nausea-vomiting and hypotension 5.1%; p < 0.001). Furthermore, we found that thrombocytosis , chest pain and weight loss were significantly associated with poor progno sis, whereas epithelial type had a positive effect on survival. Conclusion: These results suggest that OT and CP may be used as effective sclerosing a gents for pleurodesis in the control of pleural effusions associated with M PM, without major side effects. Copyright (C) 2000 S. Karger AG, Basel.