Chemical Pleurodesis for Malignant Pleural Effusions

作者：Pamela Walker-Renard, Leigh M. Vaughan, Steven A. Sahn · 发表于：Annals of Internal Medicine · 年份：1994 · DOI：10.7326/0003-4819-120-1-199401010-00010 · 被引用次数：420 · 研究领域：Pleural and Pulmonary Diseases、Lymphatic Disorders and Treatments、Ultrasound in Clinical Applications

PURPOSE: To provide information about available agents for chemical pleurodesis. DATA SOURCES: A MEDLINE search (1966 to October 1992) was conducted using the terms malignant pleural effusion and pleurodesis. STUDY SELECTION: All articles containing references to patients with recurrent, symptomatic, malignant pleural effusions treated with chemical pleurodesis were selected and reviewed for pleurodesis regimen, number of patients treated, success rate (complete response), and adverse effects. The agents studied included doxycycline, minocycline, tetracycline, bleomycin, cisplatin, doxorubicin, etoposide, fluorouracil, interferon-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 pleural effusions were reviewed for efficacy of the pleurodesis agent and studies including 1140 patients were reviewed for toxicity. Chemical pleurodesis produced a complete response in 752 (64%) of 1168 patients. The success rate of the pleurodesis agents varied from 0% with etoposide to 93% with talc. Corynebacterium parvum, the tetracyclines, and bleomycin had success rates of 76%, 67%, and 54%, respectively. The most commonly reported adverse effects were pain (265 of 1140, 23%) and fever (220 of 1140, 19%). CONCLUSIONS: Doxycycline and minocycline, with success rates of 72% and 86%, respectively, appear to be effective tetracycline-replacement agen...