緩和ケアと医学

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Pleurodesis through Pleural Catheterization in Patients with Symptomatic Malignant Pleural Effusions: Which One is better? Talc, Bleomycin or Tetracycline?

Türkmen Çiftçi, Sercan Aksoy, Çağdaş Topel*, Devrim Akıncı, Ilkay S. Idilman, Umut Arslan, Erhan Akpınar, Bülent Erbil, Mehmet Mahir Kunt, Mehmet Ali Karaca, Okan Akhan

Purpose: To analyze the results of pleurodesis through pleural catheterization using talc slurry, bleomycin, and tetracycline in patients with symptomatic malignant pleural effusion (MPE) and to compare the efficacy, reliability and outcomes of these agents.
Methods: Talc (4 g), bleomycin (60.000 U) or tetracycline (1 g) was used for chemical pleurodesis in 271 patients. Successful pleurodesis was defined as no fluid build up and lack of recurrence of symptoms within the first 30 days after treatment. Data were analyzed using SPSS 15.0 for Windows.
Results: Pleural catheterization was performed in a total of 368 patients. Eighteen patients were lost to follow-up. Seventy-nine patients were excluded due to either of the following factors; trapped lung syndrome or patient lost during the early post-catheterization period due to advanced disease. In 271 patients chemical pleurodesis was performed with talc slurry (17.3%), bleomycin (13.7%) or tetracycline (49.1%). In 19.9% of the patients, multiple chemical agents were used in different sessions as successful results were not obtained with one agent. Clinical and radiological success was achieved in 78.2% of patients. There was no significant difference among 4 groups (talc slurry, bleomycin, tetracycline and multiple agents) in terms of clinical success, complication rates and median symptom-free life periods.
Conclusion: Talc slurry, bleomycin, or tetracycline administration through percutaneous pleural catheterization have comparable efficacy rates and safety profiles. If pleurodesis failure with one agent occurs, the attempt with other agents may result in success.