PROSPECTIVE RANDOMIZED TRIAL OF TALC SLURRY VS BLEOMYCIN IN PLEURODESIS FOR SYMPTOMATIC MALIGNANT PLEURAL EFFUSIONS

Objective: Symptomatic malignant pleural effusions are common sequelae in patients with certain malignancies. Pleurodesis via bedside thorac ostomy is the current treatment option most commonly used. To our know ledge, this is the first prospective randomized trial to examine which agent, bleomycin or talc slurry, is superior in terms of effectivenes s, safety, and cost. Patients and Methods: Between July 1992 and March 1995, 35 patients presenting to our medical center with symptomatic m alignant pleural effusions mere prospectively randomized to undergo ch emical pleurodesis with either bleomycin or talc slurry via bedside th oracostomy. The conditions of patients were assessed and graded before and after treatment concerning pain, dyspnea, and chest radiographs. Results: Twenty-nine patients who underwent 33 treatments (14 with ble omycin and 19 with talc) were available for follow-up. Follow-up range d from 2 weeks to 8 months (mean, 1.7 months). Both groups demonstrate d notable improvement in both pain and dyspnea following treatment, bu t there were no statistically significant differences between groups i n the amount of improvement (two-tailed Student's t test). Permanent c ontrol of effusions, defined objectively on chest radiograph, was achi eved with 11 bleomycin treatments (79%) and 17 talc treatments (90%) ( p=0.388). The procedures were well tolerated and, no significant adver se effects were observed. Talc is a much less costly agent than bleomy cin ($12.36 cost to our medical center per treatment for talc vs $955. 83 for bleomycin). Conclusion: Given the similar efficacy and signific ant cost advantage, we conclude that talc is the agent of choice when utilizing pleurodesis for control of symptomatic malignant pleural eff usions.