ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
COMPARISON OF TALC AND OXYTETRACYCLINE WITH DIFFERENT PLEURODESIS METHODS IN TREATMENT OF MALIGNANT PLEURAL EFFUSION
Burçin Çelik1, Sedat Demircan2, Yüksel Bek3, Ahmet Başoğlu1
1Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Göğüs Cerrahisi Ana Bilim Dalı, Samsun
2Gazi Üniversitesi Tıp Fakültesi, Göğüs Cerrahisi Ana Bilim Dalı, Ankara
3Ondokuz Mayıs Üniversitesi Tıp Fakültesi, İstatistik Ana Bilim Dalı, Samsun
Background: In this study, we aimed to evaluate clinical results of pleurodesis by using different methods and sclerosant agents in treatment of malignant pleural effusion (MPE).

Methods: Forty-seven cases who underwent pleurodesis because of MPE were studied between May 2001 and September 2003. Cases were selected among the ones who had Karnofski performance status equaled to or over 60, symptomatic, expected survival was over one month, and full expantion in lungs was possible. Cases were divided into four groups. LDH, total protein, glucose, cytology were studied in pleural fluid and serum samples. Tube thoracostomy and oxytetracycline (70mg/kg) was applied to Group 1 (n = 16), thoracoscopy and pleural abration was applied to Group 2 (n = 11), thoracoscopy and talc (4 gr) was applied to Group 3 (n = 10), and tube thoracostomy and talc (4 gr) was applied to Group 4 (n = 10). Success rate of pleurodesis was evaluated by chest radiography and/or chest computerized tomography taken after 24 hours, 1 month, 3 months and 6 months.

Results: Thirty-four of the cases were female and 13 was male with mean age 58 ± 12.2 years (ranged 18 to 71 years). Mean Karnofski performance status was 76 ± 7.9. Malignant pleural effusion was diagnosed by thoracoscopic biopsy in 21 (45%) of the cases. The most frequent reason for MPE was found to be breast cancer (40%). Between groups, no significant difference could be found in pleural fluid, serum, pleural fluid/serum values. Duration of tube thoracostomy in Group 3 (4.4 ± 1.8 days) was observed to be shorter than of the other groups and it was statistically significant (p = 0.026). In evaluation of success rate of pleurodesis in groups, success was as 67% in Group 1, 77% in Group 2, 85% in Group 3 and 75% in Group 4. In 28 (59%) cases adverse effects was observed and pain (34%) was the most frequent adverse effect. Reexpansion edema was observed as a serious adverse effect in two cases who underwent thoracoscopy-talc pleurodesis.

Conclusions: Because of the short survival time in MPE, in symptomatic patients pleurodesis is applied as a palliative treatment. In pleurodesis, the selection of the patient and the method to be applied is very important. Today, thoracoscopy is an effective method in diagnosis and treatment of MPE, and talc is an effective sclerosant agent.

Keywords : Malignant pleural effusion, pleurodesis, thoracoscopy, talc, oxytetracycline
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