Chest
Volume 113, Issue 5, May 1998, Pages 1305-1311
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Clinical Investigations: The Pleura
Sclerotherapy for Malignant Pleural Effusions: A Prospective Randomized Trial of Bleomycin vs Doxycycline with Small-Bore Catheter Drainage

https://doi.org/10.1378/chest.113.5.1305Get rights and content

Background

Malignant pleural effusions are a common problem for patients with metastatic disease. Most patients are treated with tube thoracostomy and sclerotherapy, although there remains no standard approach. The purpose of this study was to compare the efficacy of bleomycin with doxycycline sclerotherapy for the treatment of malignant pleural effusions using small-bore catheters.

Methods

All patients with a symptomatic malignant pleural effusion referred for chest tube drainage and sclerotherapy over a 2-year period were considered eligible. Using image guidance, a 14F self-retaining catheter was inserted into the pleural space and connected to continuous wall suction. When drainage fell below 200 mL/d, patients were randomized to 60 U of bleomycin or 500 mg of doxycycline sclerotherapy. Response at 30 days was determined.

Results

One hundred six patients were enrolled in the study. Fifteen men (29%) and 37 women (71%) with a mean age of 57 years received bleomycin sclerotherapy. Twenty-one of the 29 patients (72%) alive and evaluable at 30 days had successful sclerotherapy. Twenty-three men (43%) and 31 women (57%) with a mean age of 61 years received doxycycline sclerotherapy. Twenty-three of the 29 patients (79%) alive and evaluable at 30 days had successful sclerotherapy. There was no significant difference in response rates between doxycycline and bleomycin (p=0.760).

Conclusions

These data continue to support a role for small-bore chest drainage and sclerotherapy, although there was no significant difference in 30-day response rates between doxycycline and bleomycin.

Section snippets

MATERIALS AND METHODS

Over a 2-year period, all patients with a known malignancy and a symptomatic, cytologically proved or strongly suspected malignant pleural effusion referred to the interventional thoracic radiology service for drainage and sclerotherapy were considered eligible. Patients who had prior sclerotherapy or a drug allergy to one of the sclerosing agents were excluded. No patient had systemic chemotherapy immediately prior to or during the 30-day interval following sclerotherapy. All patients signed

RESULTS

One hundred six patients with a mean age of 59 years were randomized to bleomycin or doxycycline sclerotherapy for the treatment of a malignant pleural effusion.

DISCUSSION

In patients >60 years, most exudative pleural effusions are caused by metastatic disease, most commonly from lung, breast, and ovarian carcinoma, and lymphoma.5, 6, 7 Approximately 50% of patients with breast carcinoma, 25% of patients with lung cancer, and 35% of patients with lymphoma will develop a malignant effusion during the course of their disease.3,8

Malignant pleural effusions are typically exudates, with high protein and lactate dehydrogenase levels. They may also be grossly

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