Rapid pleurodesis in symptomatic malignant pleural effusion.
OBJECTIVE
The objective of the study was to see whether a rapid method of pleurodesis was superior to the standard protocol in patients with symptomatic malignant pleural effusion.


METHODS
Between January 2000 and February 2003, a prospective randomised trial was carried out in a sequential sample of 27 patients with malignant pleural effusions documented cytopathologically. Twelve patients were allocated to group 1 (standard protocol) and 15 to group 2 (new protocol). A small-bore catheter (12 Fr) and oxytetracycline (35 mg/kg of body weight) were used in both groups. In group 1, patients had drainage until radiological evidence of lung re-expansion was obtained and the amount of fluid drained was less than 150 ml/day, before oxytetracycline was instilled. The catheter was removed when the amount of fluid drained after instillation was less than 150 ml/day. In group 2, patients had the oxytetracycline instilled in a fractionated-dose manner following frequent aspirations at 6h intervals. The catheter was removed when the total amount of fluid drained after instillation of the oxytetracycline [OT] was less than 150 ml/last three aspirations. Response was evaluated at 1, 3 and 6 months after pleurodesis.


RESULTS
There was no statistically significant difference in the demographic features, site of the primary tumour, disease characteristics, and response rates in any evaluation period in both groups (P>0.05). However, the number of days of drainage and hospitalisation, and the cost were significantly lower in the second group (P<0.001).


CONCLUSIONS
This new pleurodesis method provided shorter hospital stay resulting in superior cost-effectiveness and palliation without sacrificing the efficacy of pleurodesis.
Yildirim
Erkan
E
Department of Thoracic Surgery, Ankara Numune Education and Research Hospital, Ankara, Turkey. erseyda@yahoo.com
Dural
Koray
K
Yazkan
Rasih
R
Zengin
Nurullah
N
Yildirim
Dilsad
D
Gunal
Nesimi
N
Sakinci
Unal
U
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications / Q000628:therapy; D004322:Drainage / Q000379:methods; D005260:Female; D005947:Glucose / Q000032:analysis; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008175:Lung Neoplasms / Q000150:complications / Q000628:therapy; D008297:Male; D008654:Mesothelioma / Q000150:complications / Q000628:therapy; D008875:Middle Aged; D010118:Oxytetracycline / Q000008:administration & dosage; D010166:Palliative Care / Q000379:methods*; D016066:Pleural Effusion, Malignant / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
D005947:Glucose; D010118:Oxytetracycline