Comparison of the Effectiveness of Some Pleural Sclerosing Agents Used for Control of Effusions in Malignant Pleural Mesothelioma: A Review of 117 Cases

Abstract

Background and Objectives: Management of malignant pleural mesothelioma (MPM) has been an important clinical issue regardless of the treatment modality employed. We aimed to investigate the efficacy of oxytetracycline (OT), Corynebacterium parvum (CP), and nitrogen mustard (NM) in the management of pleural effusion associated with MPM. Methods: One hundred and seventeen patients 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 patients received either OT (35 mg/kg), CP (7 mg), or NM (0.4 mg/kg) through a chest tube for pleurodesis. The association between several clinical parameters and patient survival was also investigated. Results: OT was applied 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 higher rate of successful pleurodesis as compared to NM (30 days, 48.2%; 90 days, 41.3%; p <0.05). Although the procedure was generally well tolerated by the patients, the NM-treated group experienced significantly more nausea-vomiting (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 prognosis, whereas epithelial type had a positive effect on survival. Conclusion: These results suggest that OT and CP may be used as effective sclerosing agents for pleurodesis in the control of pleural effusions associated with MPM, without major side effects.

Rapid pleurodesis in symptomatic malignant pleural effusion

“…Second, it was impossible to find talc out of asbestos in Turkey, also more expensive. Lastly, OT was known to be well tolerated by the patients without major side effects [7].…”

“…The total dose of OT to be administered was calculated as 35 mg/kg of body weight [7]. The first fractionated dose, which was half of the total, was administered intrapleurally immediately after the first aspiration.…”

Comparison of side effects of oxytetracycline and talc pleurodesis: an experimental study

“…Oxytetracycline, a derivative of Streptomyces rimosus, was introduced in 1950 and has been an easily accessible drug in Turkey [10]. However, it was published in few clinical studies probably due to some ethical reasons [9-11].…”

“…Şenyigit et al administered oxytetracycline at a dose of 35 mg/kg, and it was well tolerated by patients with minor side effects like nausea-vomiting and hypotension (4.3%), chest pain (30.4%), fever (23.1%). Thus, the authors considered the results acceptable [10]. Yıldırım et al have reported only pleuritic pain which was managed by intrapleurally analgesia [9].…”

Management of Malignant Pleural Effusions: Minimally Invasive Techniques

“…Malign plevral efüzyon saptanan hastalarda primer tümör tipleri ve sıklıkları lan plörodeze göre daha etkin olduğu sonucuna varılmıştır (33). Çeşitli ajanların plörodez başarısı sonuçlarının ortaya konduğu bazı çalışmalar Tablo 2'te özetlenmiştir (34).…”