Chemical pleurodesis for malignant pleural effusion

Background and Objectives: Malignant pleural effusion is a common complication of primary and metastatic pleural malignancies. It is usually managed by drainage and pleurodesis, but there is no consensus as to the best method of pleurodesis, this study was designed to compare the effectiveness, side effects, and cost of different chemical pleurodesis agents used in patients with malignant pleural effusion. Methods: Seventy-five patients with malignant pleural effusion were assigned into five groups each of 15 patients, Talc slurry 5 gm, Tetracycline500 mg, Bleomycin1 IU/kg, Iodopovidone (2%) and patients underwent tube drainage only. Tube thoracotomy was performed in all patients and agents were administered through the chest tubes. Results: Tetracycline, talc slurry, iodopovidone andbleomycin, resulted inan insignificantly different success rates of 80%, 80%, 66.6%.73.3%, at 30 days and, 66.6%, 73.3%, 60%, 66.6%, at 60 days respectively while tube alone was much lower, 40% and 26.7% respectively. Chest tubes were removed after an average of 7.2 ± 1.4 days for tetracycline, 7 ± 0.8 days for talc slurry, 7.6 ± 0.9 days for iodopovidone and 6.4 ± 1.5 days for bleomycin which did not differ significantly. Chest pain was more common in the tetracycline group, dyspnea was more common in the talc group, and fever was more common in the iodopovidone group. Conclusion: Since tetracycline, talc slurry, iodopovidone, andbleomycin achieved comparable success rates in this study, we suggest that the drug availability and cost are important factors in choosing a sclerosing agent in developing countries