Small chest-tube drainage followed by bleomycin sclerosis for malignant pleural effusions.
OBJECTIVE
To review our experience with bleomycin sclerotherapy as treatment of pleural effusions due to gynecologic malignancies.


METHODS
Twenty-one women with histologically documented malignant effusions (16 ovarian carcinoma, three uterine sarcoma, and two cervical cancer) were treated with small flexible chest-tube drainage followed by intrapleural bleomycin sclerotherapy (60 units).


RESULTS
After placement of the chest tube, suction was required for a median of 5 days (range 3-12) before output was low enough (less than 100 mL/24 hours) to instill bleomycin. Among 24 treated effusions, there was a 71% overall response rate, including ten complete responses (42%) and seven partial responses (29%); seven effusions (29%) did not respond to therapy. Six of the seven patients whose effusions did not respond to bleomycin died of disease within 2 months of attempted sclerotherapy. Fever was the most common side effect, occurring in 13 of 21 patients (62%) following instillation of bleomycin. Pain during sclerosis was reported by only two patients.


CONCLUSIONS
Bleomycin sclerotherapy after small flexible chest-tube drainage of malignant pleural effusions is an effective technique, with minimal adverse reactions, for controlling effusions that develop in women with gynecologic malignancies.
Goff
B A
BA
Vincent Memorial Gynecologic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston.
Mueller
P R
PR
Muntz
H G
HG
Rice
L W
LW
D001761:Bleomycin / Q000627:therapeutic use*; D015505:Chest Tubes; D005260:Female; D006801:Humans; D007322:Instillation, Drug; D010051:Ovarian Neoplasms / Q000150:complications; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D015911:Sclerotherapy; D013396:Suction; D013997:Time Factors
D001761:Bleomycin