Sclerotherapy for Malignant Pleural Effusions- A Prospective Randomized Trial of Vincristine Versus Cisplatin

Abstract

BACKGROUNDMalignant pleural effusions are a common cause of morbidity in patients with advanced cancer. Cancer of the lung breast and lymphomas account for approximately 75 % of malignant pleural effusions. Sarcomas and melanomas account for a small percentage of malignant pleural effusion. In about 6 % of patients the primary is unknown.The aim of the study is to evaluate the efficacy of pleurodesis using Vincristine and Cisplatin and to compare the outcomes of pleurodesis with these two sclerosing agents in malignant pleural effusions. MATERIALS AND METHODSAll patients with malignant pleural effusion were evaluated and patients with previous sclerotherapy, hepatic or renal dysfunction were excluded. Patients eligible for pleurodesis were randomized by "Randomisation by Blocking" technique into two groups. They received either Vincristine (2 mgs/m2) or Cisplatin (70 mgs/m2) intrapleurally through the intercostal tube as per BTS guidelines on management of malignant pleural effusions. Patients were evaluated for response after four weeks. Design-Prospective randomized clinical trial. RESULTS48 cases of malignant pleural effusions were evaluated. 30 cases were excluded for reasons for reasons such as rapid progression of the disease(13), non expansion of lung (15) and not willing for further treatment(2). 18 eligible patients were included for the study and randomized to receive either Vincristine or Cisplatin. Out of 10 patients who received Vincristine sclerotherapy, complete response was noted in 60 % and objective response (complete plus partial responses) in 70 %. Out of 8 patients who received Cisplatin sclerotherapy, complete and objective response was noted in 87.5 %. There was no significant differences in response rates between Vincristine and Cisplatin either in complete response (p = 0.315) or in objective response (p = 0.588). CONCLUSIONBoth Vincristine and Cisplatin are effective sclerosing agents in malignant pleural effusions, though neither agent was superior to the other in this study. Since Vincristine is cheaper, it is more cost effective agent for pleurodesis in malignant pleural effusions.