Pleurodesis in recurrent pleural effusions: a randomized comparison of a classical and a currently popular drug.
OBJECTIVE
Pleurodesis is generally regarded to give the best palliation in recurrent pleural effusion. Talc is now increasingly recommended but in our department quinacrine has been used successfully for many decades with good results and only minor side effects. It was therefore decided to make a prospective randomized clinical study comparing quinacrine (500 mg) with talc (5 g) with regard to efficacy and safety.


METHODS
One hundred and ten eligible consecutive patients with recurrent and or malignant effusions, from 1 March 1996 till 31 March 1999 were randomized to chemical pleurodesis with either talc or quinacrine through a chest drainage tube after medical thoracoscopy. Patients were evaluated with chest radiographs at 2 weeks and 2, 4, and 6 months after pleurodesis.


RESULTS
Chi-square test showed 84% power to distinguish between the groups and 10% to determine the primary endpoint. Primary success (fluid production < 50ml/24h within the first 6 days) was 96% of 56 patients with talc and 91% of 54 patients with quinacrine, a non-significant difference (P = 0.46). Quinacrine patients needed a repeated treatment in 31% (17 patients) and talc patients in 7% (4 patients) (P < 0.05). Side effects were minor with no significant difference between the substances.


CONCLUSIONS
Both substances are effective. Talc treatment had less often to be repeated. This indicates that the recommendation of talc for pleurodesis is well founded. However, quinacrine is a good alternative.
Ukale
Valiant
V
Department of Medicine, Division of Respiratory Medicine, Thoracic Clinics, Karolinska Sjukhuset, S-171 76 Stockholm, Sweden. valiant.ukale@ks.se
Agrenius
Veronica
V
Hillerdal
Gunnar
G
Mohlkert
Dag
D
Widström
Olle
O
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009369:Neoplasms / Q000188:drug therapy; D016066:Pleural Effusion, Malignant / Q000139:chemically induced / Q000188:drug therapy* / Q000473:pathology; D018700:Pleurodesis / Q000379:methods*; D011446:Prospective Studies; D011796:Quinacrine / Q000008:administration & dosage*; D013627:Talc / Q000008:administration & dosage*; D013906:Thoracoscopy; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D013627:Talc; D011796:Quinacrine