A randomized trial of intracavitary bleomycin and corynebacterium parvum in the control of malignant pleural effusions

Ostrowski, Marek; Priestman, T. J.; Houston, R.F.; Martin, W.M.C.

doi:10.1016/0167-8140(89)90004-2

Cited by 32 publications

(13 citation statements)

References 12 publications

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“…In our study, an effective pleurodesis was ob tained in 90% of the patients using one or two instillations of CBP, and in 10% using three doses. These results are similar to those reported by some authors [10][11][12][13]18], but more satisfactory than those of Casali et al [15], who used 4 mg of CBP, whereas we and other authors used 7 mg [8,[10][11][12][13][14][16][17][18], Casali et al achieved C R in 30% of patients with two CBP injections and in 70% with three and four CBP injections. The mechanism of action of the drug is still unknown.…”

Section: Discussionsupporting

confidence: 72%

“…The frequency of fever in our study is 50%, and 3 patients had prolonged and/or high fever. Only one pa tient had moderate chest pain compared with 32-57% of the patients reported by other authors [10,12,13,15,17], None of the patients presented other side effects, in par ticular allergic reactions. Unlike other substances [3,5], intrapleurally instillated CBP is performed without inter costal drainage.…”

Section: Discussionmentioning

confidence: 78%

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Intrapleural <i>Corynebacterium parvum</i> for Recurrent Malignant Pleural Effusions

Foresti

1995

Respiration

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Twenty-two consecutive patients with malignant pleural effusions (MPE) were treated with intrapleural Corynebacterium parvum (CBP) associated with parenteral methylprednisolone (MP) to determine its effectiveness and the frequency and nature of adverse reactions. After thoracentesis, 7 mg of CBP (Coparvax Wellcome) in 20 ml of saline were injected into the pleural cavity. On the day of treatment, the patients were given 1 mg/kg i.m. of MP 30 min before thoracentesis. The effectiveness of pleurodesis was assessed as follows: (1) complete response (CR; total resolution of pleural effusion after 3 injections of CBP at the most); (2) partial response (PR; formation of asymptomatic loculated effusion). In 5 patients leukocytes, lymphocytes and monocytes were determined in pleural fluid (PF) and in blood (B) collected before and 7 days after CBP treatment. Two patients were unevaluable. Of 20 evaluable patients, 18 (90%) had a CR and 2 patients (10%) had a PR. Eleven of 22 patients (50%) had a fever. Three patients had prolonged and/or high fever. Seven of 22 patients (32%) had mild chest pain. None of the patients presented other side effects. Twelve of 21 patients (57.1%) had a PF pH > 7.30; 2 of these died a few days after the treatment, and 10 had favorable responses. The other 9 patients had a PF pH < 7.30: all had favorable responses. The leukocytes, the lymphocyte subsets, the monocytes, the NK lymphocytes, and their PF/B ratios did not differ significantly before and after CBP treatment. Our study confirms that intrapleural CBP is an effective and simple method to control MPE. The combination of MP with CBP did not prevent effective pleurodesis and seems to reduce the frequency of adverse reactions, except fever.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 78%

Intrapleural <i>Corynebacterium parvum</i> for Recurrent Malignant Pleural Effusions

Foresti

1995

Respiration

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“…4) [14,[22][23][24][25][26][27][28][29][30][31][32][33], bleomycin (Fig. 5) [34][35][36][37][38] and intrapleural chemotherapy and immunotherapy ( Fig. 6) [39][40][41][42].…”

Section: Which Is the Best Agent For Pleurodesis?mentioning

confidence: 99%

The evidence on the effectiveness of management for malignant pleural effusion: a systematic review

Tan

Sedrakyan

Browne

et al. 2006

European Journal of Cardio-Thoracic Surgery

233

119

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The aim of this study was to review systematically the available evidence on pleurodesis for malignant effusion, focusing on the choice of the agents, route of delivery and other strategies to improve outcomes. Four electronic databases (MEDLINE, EMBASE, Web of Science and Cochrane Controlled Trials Register) were searched, reference lists checked and letters requesting details of unpublished trials and data sent to authors of previous trials. Studies of malignant pleural effusion in humans were selected with no language restrictions applied. Criteria for randomised clinical trial (RCT) eligibility were random allocation of patients and non-concurrent use of another experimental medication or device. Methodological quality evaluation of the trials was based on randomisation, blinding, allocation concealment and intention to treat analysis. A random effect model was used to combine the relative risk estimates of the treatment effects whenever pooling for an overall effect was considered appropriate. Forty-six RCTs with a total of 2053 patients with malignant pleural effusions were reviewed for effectiveness of pleurodesis. Talc tended to be associated with fewer recurrences when compared to bleomycin (RR, 0.64; 95% CI, 0.34-1.20) and, with more uncertainty, to tetracycline (RR, 0.50; 95% CI, 0.06-4.42). Tetracycline (or doxycycline) was not superior to bleomycin (RR, 0.92; 95% CI, 0.61-1.38). When compared with bedside talc slurry, thoracoscopic talc insufflation was associated with a reduction in recurrence (RR, 0.21; 95% CI, 0.05-0.93). Strategies such as rolling the patient after instillation of the sclerosing agent, protracted drainage of the effusion and use of larger chest tubes were not found to have any substantial advantages. Talc appears to be effective and should be the agent of choice for pleurodesis. Thoracoscopic talc insufflation is associated with fewer recurrences of effusions compared with bedside talc slurry, but this is based on two small studies. Where thoracoscopy is unavailable bedside talc pleurodesis has a high success rate and is the next best option.

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“…Almost exclusively used in some European centres, the average effectiveness of this procedure has been reported to be 76%. However, in a randomized study with bleomycin it was effective in only 32% of cases [47].…”

Section: Doxycyclinementioning

confidence: 99%

Pleurodesis: state of the art

Rodríguez-Panadero

Antony²

1997

Eur Respir J

169

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Pleurodesis aims to achieve a symphysis between parietal and visceral pleural surfaces, in order to prevent accumulation of fluid or air in the pleural space. Its major indications are malignant effusions and pneumothorax, and a reexpandable lung is essential for the success of the technique. Moreover, expectation of a reasonably long survival is important before attempting pleurodesis.A successful lung re-expansion is unlikely if the pleural pressure falls more than 20 cmH 2 O·L -1 of fluid removed, because there is a central bronchial obstruction or the lung is trapped by tumour and/or fibrin. Pleural fluid pH (<7.20) is a good indicator of the presence of trapped lung; moreover, a successful pleurodesis is less likely when pH is low, and this parameter is also a good predictor for survival of the patients.Among the many sclerosing agents that have been used for pleurodesis, talc has achieved the best results, with an average success rate of approximately 90%. The cellular and biochemical mechanisms involved in pleurodesis may be specific to the agent used, however, they may all follow a common final pathway leading to activation of the pleural coagulation cascade, the appearance of fibrin networks, and the proliferation of fibroblasts. The details of these mechanisms are still unclear and need to be further elaborated. Eur Respir J 1997; 10: 1648-1654 The aim of pleurodesis is to achieve a symphysis between visceral and parietal pleural layers, in order to prevent accumulation of either air or fluid in the pleural space. Its main indications are malignant pleural effusions and pneumothorax. The choice of the right technique, sclerosing agent to be applied, criteria for selection of patients and evaluation of results are important and controversial issues. Furthermore, there is little information about the mechanisms that lead to pleural symphysis or the factors that influence the outcome of pleurodesis. Pleurodesis in malignant effusionsRecurrent effusions of malignant origin are by far the most common indication for pleurodesis in clinical practice. This is because there is a lack of effective antitumoral treatment at later stages of the disease, and because palliative measures are necessary to improve symptoms related to the pleural effusion. Repeated thoracenteses are not usually suitable, since they may be troublesome to the patient and provoke important protein loss (about 40 g·L -1 of pleural fluid that is withdrawn), with infection of the pleural space as an added risk.

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A randomized trial of intracavitary bleomycin and corynebacterium parvum in the control of malignant pleural effusions

Cited by 32 publications

References 12 publications

Intrapleural <i>Corynebacterium parvum</i> for Recurrent Malignant Pleural Effusions

Intrapleural <i>Corynebacterium parvum</i> for Recurrent Malignant Pleural Effusions

The evidence on the effectiveness of management for malignant pleural effusion: a systematic review

Pleurodesis: state of the art

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