Silver nitrate versus tetracycline in pleurodesis for malignant pleural effusions; a prospective randomized trial

Authors

Department of Thorax Surgery, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: In this study, we aimed to investigate the effectiveness of silver nitrate (SN) versus tetracycline in pleurodesis among patients with malignant pleural effusion (MPE).
Methods: In this prospective randomized clinical trial, patients with unilateral MPE candidate for pleurodesis were enrolled. The patients randomly allocated in two groups for receiving 20 mL 0.5% SN or 2.5 g tetracycline diluted in 30 cc normal saline and 0.1% lidocaine, through the chest tube. Patients were followed-up immediately (during 24 h) and 1-month after the procedure for evaluating recurrence of the pleural effusion using chest radiograph. They were clinically evaluated for chest pain and/or dyspnea and fever using a questionnaire that completed by the surgeon. The results were compared with two groups.
Results: During this trial, 50 patients with MPE candidate for pleurodesis were selected and randomized into two interventional groups (25 patients in each group). Immediate and late recurrence of pleural effusion after pleurodesis were similar in two groups (P > 0.05). All patients in tetracycline group had fever and chest pain, but in SN group fever and chest pain were reported in 3 (12%) and 12 (48%) of patients, respectively (P < 0.05).
Conclusion: SN is at least as effective as tetracycline for MPE treatment. In addition, its side effects were lower than tetracycline. Other advantages of SN are its low cost, availability, and safety. For more accurate results, it is recommended to design further trials with larger sample size and with lower doses of both SN and tetracycline.

Keywords

1.
Uzbeck MH, Almeida FA, Sarkiss MG, Morice RC, Jimenez CA, Eapen GA, et al.Management of malignant pleural effusions. Adv Ther 2010;27:334-47.  Back to cited text no. 1
    
2.
Arber A, Clackson C, Dargan S. Malignant pleural effusion in the palliative care setting. Int J Palliat Nurs 2013;19:320, 2-5.  Back to cited text no. 2
    
3.
Suárez PM, Gilart JL. Pleurodesis in the treatment of pneumothorax and pleural effusion. Monaldi Arch Chest Dis 2013;79:81-6.  Back to cited text no. 3
    
4.
Muduly D, Deo S, Subi TS, Kallianpur A, Shukla N. An update in the management of malignant pleural effusion. Indian J Palliat Care 2011;17:98-103.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Nam HS. Malignant pleural effusion: Medical approaches for diagnosis and management. Tuberc Respir Dis (Seoul) 2014;76:211-7.  Back to cited text no. 5
    
6.
Bakr RM, El-Mahalawy II, Abdel-Aal GA, Mabrouk AA, Ali AA. Pleurodesis using different agents in malignant pleural effusion. Egypt J Chest Dis Tuberc 2012;61:399-404.  Back to cited text no. 6
    
7.
Lee YC, Baumann MH, Maskell NA, Waterer GW, Eaton TE, Davies RJ, et al.Pleurodesis practice for malignant pleural effusions in five English-speaking countries: Survey of pulmonologists. Chest 2003;124:2229-38.  Back to cited text no. 7
    
8.
Hashemzadeh S, Hashemzadeh K, Mamaghani K, Ansari E, Aligholipour R, Golzari SE, et al.Pleurodesis by erythromycin, tetracycline, Aerosil™ 200, and erythromycin plus Aerosil™ 200 in a rat model: A preliminary study. Daru 2012;20:79.  Back to cited text no. 8
    
9.
Dikensoy O, Light RW. Alternative widely available, inexpensive agents for pleurodesis. Curr Opin Pulm Med 2005;11:340-4.  Back to cited text no. 9
    
10.
Bouros D, Froudarakis M, Siafakas NM. Pleurodesis: Everything flows. Chest 2000;118:577-9.  Back to cited text no. 10
    
11.
Tremblay A, Stather DR, Kelly MM. Effect of repeated administration of low-dose silver nitrate for pleurodesis in a rabbit model. Respirology 2011;16:1070-5.  Back to cited text no. 11
    
12.
Terra RM, Kim SY, Pego-Fernandes PM, Teixeira LR, Vargas FS, Jatene FB. Is silver nitrate pleurodesis for patients with malignant pleural effusion feasible and safe when performed in an outpatient setting? Ann Surg Oncol 2011;18:1145-50.  Back to cited text no. 12
    
13.
Krasnik M, Christensen B, Halkier E, Høier-Madsen K, Jelnes R, Wied U. Pleurodesis in spontaneous pneumothorax by means of tetracycline. Follow-up evaluation of a method. Scand J Thorac Cardiovasc Surg 1987;21:181-2.  Back to cited text no. 13
    
14.
Tettey M, Sereboe L, Edwin F, Frimpong-Boateng K. tetracycline pleurodesis for malignant pleural effusion – A review of 38 cases. Ghana Med J 2005;39:128-31.  Back to cited text no. 14
    
15.
Chen H, Brahmer J. Management of malignant pleural effusion. Curr Oncol Rep 2008;10:287-93.  Back to cited text no. 15
    
16.
Mohamed KH, Hassan OA. A new look at an old agent for pleurodesis. Egypt J Chest Dis Tuberc 2013;62:617-20.  Back to cited text no. 16
    
17.
Rafiei R, Yazdani B, Ranjbar SM, Torabi Z, Asgary S, Najafi S, et al.Long-term results of pleurodesis in malignant pleural effusions: Doxycycline vs Bleomycin. Adv Biomed Res 2014;3:149.  Back to cited text no. 17
    
18.
Shouman W, Elgazzar A, Hussien RM, El Shaaray M, Light RW. Chemical pleurodesis for malignant pleural effusion. Egypt J Chest Dis Tuberc 2012;61:115-20.  Back to cited text no. 18
    
19.
Musani AI. Treatment options for malignant pleural effusion. Curr Opin Pulm Med 2009;15:380-7.  Back to cited text no. 19
    
20.
Light RW, Lee YC. Textbook of Pleural Diseases. Ch. 22. London: Arnold Publisher; 2003. p. 97.  Back to cited text no. 20
    
21.
Kilic D, Akay H, Kavukçu S, Kutlay H, Cangir AK, Enön S, et al.Management of recurrent malignant pleural effusion with chemical pleurodesis. Surg Today 2005;35:634-8.  Back to cited text no. 21
    
22.
Vargas FS, Teixeira LR, Silva LM, Carmo AO, Light RW. Comparison of silver nitrate and tetracycline as pleural sclerosing agents in rabbits. Chest 1995;108:1080-3.  Back to cited text no. 22
    
23.
Marshall BC, Santana A, Xu QP, Petersen MJ, Campbell EJ, Hoidal JR, et al.Metalloproteinases and tissue inhibitor of metalloproteinases in mesothelial cells. Cellular differentiation influences expression. J Clin Invest 1993;91:1792-9.  Back to cited text no. 23
    
24.
Wallach HW. Intrapleural tetracycline for malignant pleural effusions. Chest 1975;68:510-2.  Back to cited text no. 24
    
25.
Menna C, Andreetti C, Ibrahim M, Maurizi G, Poggi C, Barile R, et al.The effect of silver nitrate pleurodesis after a failed thoracoscopic talc poudrage. Biomed Res Int 2013;2013:295890.  Back to cited text no. 25
    
26.
Paschoalini Mda S, Vargas FS, Marchi E, Pereira JR, Jatene FB, Antonangelo L, et al.Prospective randomized trial of silver nitrate vs talc slurry in pleurodesis for symptomatic malignant pleural effusions. Chest 2005;128:684-9.  Back to cited text no. 26
    
27.
Marchi E, Vargas FS, Acencio MM, Antonangelo L, Teixeira LR, Light RW. Low doses of silver nitrate induce pleurodesis with a limited systemic response. Respirology 2009;14:885-9.  Back to cited text no. 27
    
28.
Andreetti C, D'Andrilli A, Ibrahim M, Poggi C, Maurizi G, Vecchione A, et al.Submucosal injection of the silver-human albumin complex for the treatment of bronchopleural fistula. Eur J Cardiothorac Surg 2010;37:40-3.  Back to cited text no. 28