Talc powder vs doxycycline in the control of malignant pleural effusion: a prospective, randomized trial.
BACKGROUND
Malignant pleural effusion is a common problem in advanced cancers, contributing to the poor quality of life in this group of patients. The aim of the study was to assess the efficiency of talc powder and doxycycline in pleurodesis in patients with malignant pleural effusion in comparable conditions.


METHODS
Of 52 patients screened, 33 entered the trial. They were randomized to the talc group (n=18) and the doxycycline group (n=15). Both groups were comparable with regard to age, sex and the most important variables influencing effectiveness of the procedure, i.e. primary malignancy and stage of metastatic involvement of the pleura. Efficiency of pleurodesis was prospectively assessed.


RESULTS
The analysis of short-term effectiveness of pleurodesis in the first 33 patients has shown a highly significant difference in favor of talc powder (p=0.009); this difference was the reason for terminating the randomization. Further observation has revealed in the doxycycline group an increasing number of patients with fluid reaccumulation, as time went by; this was not observed in the talc group. A statistical analysis of the long-term effectiveness of both agents studied has shown a more significant difference in favor of the talc powder (p=0.00003).


CONCLUSIONS
Talc powder is superior to doxycycline in achieving pleurodesis in patients with malignant pleural effusion, in both short- and long-term observations.
Kuzdzał
Jarosław
J
Department of Thoracic Surgery, Specialized Hospital of Pulmonary Medicine, Zakopane, Poland. jaroslaw@mp.pl
Sładek
Krzysztof
K
Wasowski
Dariusz
D
Soja
Jerzy
J
Szlubowski
Artur
A
Reifland
Agnieszka
A
Zieliński
Marcin
M
Szczeklik
Andrzej
A
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications / Q000469:parasitology; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009382:Neoplasms, Unknown Primary / Q000150:complications / Q000469:parasitology; D016066:Pleural Effusion, Malignant / Q000517:prevention & control*; D013627:Talc / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D013627:Talc; D004318:Doxycycline