Drainage of the Pleural Cavity and Chemical Pleurodesis for Malignant Pleural Effusion - Comparison of Bleomycin and Doxycycline

Abstract

Malignant pleural effusion (MPE) may be an indication for palliative treatment to improve the quality of life and allow patients to leave the hospital. The most common treatment for MPE is drainage of the pleural cavity followed chemical pleurodesis. The aim of the study was to compare the efficacy of Bleomycin and Doxycycline for pleurodesis. Material and methods. Between 1996 and 2006, 105 patients (aged 30-84) were treated in the Wrocław Thoracic Surgery Centre for MPE using drainage of the pleural cavity followed by Bleomycin or Doxycycline for chemical pleurodesis. Lung cancer was diagnosed in 53 patients (49.5%), other malignancy in 49 patients (46.7%), and the primary focus was not established in 4 (3.8%) patients. Patients were divided into two groups: group I (n=56) consisted of patients who underwent pleurodesis with Bleomycin (60 mg), and group II (n=49) consisted of patients treated with Doxycycline (1 g or 0,5 g). Patients were divided into two subgroups. Subgroup A (n=31) included patients who died within the first month, and subgroup B (n=74) included patients who lived longer. Results. In subgroup A, total remission was achieved in 100% of group I -patients and 78.6% of group II -patients, respectively. There were no statistically significant differences (SSDs) between groups (p>0.05). In subgroup B, remission was analyzed after 1, 3, 6, and 9 months. Total remission after 9 months was achieved in 84.6% and 77.1% of patients in groups I and II, respectively. There were no statistical differences between groups. The median mean rate survival in groups I and II was 251 and 242 days, respectively (p>0.05). Drainage complications and side effects were analyzed. Conclusions. Better results were achieved following the use of Bleomycin than Doxycycline, but there were no SSDs between groups, nor were three any SSDs in survival length between groups. The most common side effect was pain, which occurred more frequently after treatment with Doxycycline than Bleomycin.