title: Release of growth factors after mechanical and chemical pleurodesis for treatment of malignant pleural effusion: a randomized control study.
abstract: BACKGROUND
  Growth factors are key inducers of fibrosis but can also mediate inflammatory responses resulting in increasing pleural effusion and acute respiratory distress syndrome. The primary aim of the study was to analyse growth factors release after performing chemical and mechanical pleurodesis in the first 48 hours at the patients with malignant pleural effusion. The secondary endpoints were to evaluate the effectiveness of the both pleurodeses, symptoms release and the quality of life of patients after the treatment.
  
  
  METHODS
  A prospective randomized study included 36 consecutive female patients with breast carcinoma and malignant pleural effusion in an intention-to-treat analysis. We treated 18 patients by means of thoracoscopic mechanical pleurodesis and 18 patients by chemical pleurodesis with talcum applied over a chest tube. We gathered the pleural fluid and serum samples in the following 48 hours under a dedicated protocol and tested them for growth factors levels. A quality of life and visual analogue pain score surveys were also performed.
  
  
  RESULTS
  Median measured serum vascular endothelial growth factor (VEGF) level after chemical pleurodesis was 930.68 pg/ml (95% CI: 388.22-4656.65) and after mechanical pleurodesis 808.54 pg/ml. (95% CI: 463.20-1235.13) (p = 0.103). Median pleural levels of transforming growth factor (TGF) β1 were higher after performing mechanical pleurodesis (4814.00 pg/ml [95% CI: 2726.51-7292.94]) when compared to those after performing chemical pleurodesis (1976.50 pg/ml [95% CI: 1659.82-5136.26]) (p = 0.078). We observed similar results for fibroblast growth factor (FGF) β; the serum level was higher after mechanical pleurodesis (30.45 pg/ml [95% CI: 20.40-59.42]), compared to those after chemical pleurodesis (13.39 pg/ml [95% CI: 5.04 - 74.60]) (p = 0.076). Mechanical pleurodesis was equally effective as chemical pleurodesis in terms of hospital stay, pleural effusion re-accumulation, requiring of additional thoracentesis, median overall survival, but, it shortened the mean thoracic drainage duration (p = 0.030) and resulted in a higher symptoms release and in a better quality of life (p = 0.047).
  
  
  CONCLUSIONS
  We recorded an increase in serum VEGF levels after chemical pleurodesis, however on the contrary, an increase in the pleural fluid level of TGFβ1 and FGFβ] after mechanical pleurodesis with respect to compared group. Although the differences did not reach statistical significance, VEGF, TGFβ1 and FGFβ remain the most interesting parameters for future research. Considering the mechanisms of growth factors action, we conclude that in our study group mechanical pleurodesis might be more efficient in terms of growth factors release, thoracic drainage duration and resulted in a higher symptoms release and in a better quality of life than chemical pleurodesis.
authors.affiliation: Department of Thoracic Surgery, University Medical Centre Maribor, Slovenia.
authors.forename: Aljaz
authors.initials: A
authors.lastname: Hojski
authors.affiliation: Biochemistry Division, Medical Faculty, University of Maribor, Maribor Slovenia.
authors.forename: Maja
authors.initials: M
authors.lastname: Leitgeb
authors.affiliation: Department of Thoracic Surgery, University Medical Centre Maribor, Slovenia.
authors.forename: Anton
authors.initials: A
authors.lastname: Crnjac
keywords: growth factors; malignant pleural effusion; pleurodesis; quality of life
references.citation: Radiol Oncol. 2014 Jan 22;48(1):80-6
references.pmid: 24587784
references.citation: Wound Repair Regen. 2009 Mar-Apr;17(2):153-62
references.pmid: 19320882
references.citation: Radiol Oncol. 2014 Apr 25;48(2):184-8
references.pmid: 24991208
references.citation: Eur J Cardiothorac Surg. 2011 Aug;40(2):277-9
references.pmid: 21194963
references.citation: Clin Cancer Res. 1999 Nov;5(11):3364-8
references.pmid: 10589746
references.citation: J Transl Med. 2012 Sep 03;10:183
references.pmid: 22943793
references.citation: Lung Cancer. 2011 Dec;74(3):392-5
references.pmid: 21616551
references.citation: Eur J Cardiothorac Surg. 2006 May;29(5):829-38
references.pmid: 16626967
references.citation: J Mammary Gland Biol Neoplasia. 2005 Oct;10(4):283-90
references.pmid: 16924371
references.citation: Am J Respir Crit Care Med. 2001 Nov 1;164(9):1601-5
references.pmid: 11719296
references.citation: J BUON. 2006 Oct-Dec;11(4):463-7
references.pmid: 17309178
references.citation: Chest. 2004 Nov;126(5):1522-8
references.pmid: 15539722
references.citation: J Natl Cancer Inst. 1993 Mar 3;85(5):365-76
references.pmid: 8433390
references.citation: Chest. 2014 May;145(5):1141-3
references.pmid: 24798838
references.citation: Lung Cancer. 2012 Aug;77(2):443-9
references.pmid: 22487430
references.citation: Respir Med. 2009 Jan;103(1):91-7
references.pmid: 18789662
references.citation: Radiol Oncol. 2013 Mar;47(1):57-62
references.pmid: 23450278
references.citation: Am J Respir Crit Care Med. 2001 Mar;163(3 Pt 1):640-4
references.pmid: 11254517
references.citation: Respir Med. 2009 Apr;103(4):595-600
references.pmid: 19046861
references.citation: Eur J Cardiothorac Surg. 2004 Aug;26(2):432-6
references.pmid: 15296910
references.citation: Interact Cardiovasc Thorac Surg. 2011 May;12(5):818-23
references.pmid: 21325469
references.citation: Int J Biochem Cell Biol. 2004 Jun;36(6):1031-7
references.pmid: 15094118
references.citation: Wien Klin Wochenschr. 2006 Aug;118(15-16):479-84
references.pmid: 16957979
references.citation: Neoplasma. 2004;51(5):334-40
references.pmid: 15640936
references.citation: Anticancer Drugs. 2012 Feb;23(2):230-8
references.pmid: 22027538
references.citation: Lung Cancer. 2004 Sep;45(3):325-37
references.pmid: 15301873
references.citation: Clin Chest Med. 2013 Mar;34(1):xi
references.pmid: 23411064
references.citation: Wien Klin Wochenschr. 2004;116 Suppl 2:28-32
references.pmid: 15506307
references.citation: Respir Med. 2008 Dec;102(12):1708-14
references.pmid: 18760578