Long-term results of pleurodesis in malignant pleural effusions: Doxycycline vs Bleomycin

Authors
Rahmatollah Rafiei 1
Behnam Yazdani 1
Sayed Milad Ranjbar 1
Zahra Torabi 1
Sedigheh Asgary 2
Somayeh Najafi 3
Mahtab Keshvari 2
1 Islamic Azad University, Najafabad Branch, Najafabad, Isfahan, Iran
2 Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan, Iran
3 Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: The aim of this study was to compare the response of doxycycline and bleomycin in pleurodesis of malignant pleural effusions.
Materials and Methods: The radiologic and clinical responses of doxycycline and bleomycin in pleurodesis of malignant pleural effusions were compared in this randomized clinical trial. Forty-two patients were randomized to receive either bleomycin 45 mg or doxycycline 600 mg as the sclerotherapy agent. Chest X-rays were taken before and after intervention, 10 days and 2 months later to compare the radiologic response. Dyspnea and other side effects, before and after intervention, 10 days and 2 months later were recorded and compared. Chi-square test was applied to analyze the data.
Results: The prevalence of dyspnea and its different severities, 10 days and 2 months after intervention were significantly different (P < 0.05) between the two groups. Analysis of pleural effusions revealed a significant difference (P < 0.05) between Doxycycline vs. Bleomycin 2 months after the intervention. Three months after pleurodesis, only one patient in bleomycin group needed pleural fluid drainage.
Conclusion: Pleural effusions did not change with use of doxycycline and bleomycin in short time but long-term results of doxycycline sclerotherapy was better than bleomycin sclerotherapy in malignant pleural effusions that was supported by this study. However, additional studies with larger sample size are necessary to confirm the results.

Keywords

1. Marchi E, Teixeira LR, Vargas FS. Management of malignancy-associated pleural effusion: Current and future treatment strategies. Am J Respir Med 2003;2:261-73.  Back to cited text no. 1
    
2. American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med 2000;162:1987-2001.  Back to cited text no. 2
    
3. Antunes G, Neville E. Management of malignant pleural effusions. Thorax 2000;55:981-3.  Back to cited text no. 3
    
4. Andrews CO, Gora ML. Pleural effusions: Pathophysiology and management. Ann Pharmacother 1994;28:894-903.  Back to cited text no. 4
    
5. Dimitriadis KA. Malignant pleural effusions. Arch Oncol 2001;9:2.  Back to cited text no. 5
    
6. Bielsa S, Hernandez P, Rodriguez-Panadero F, Taberner T, Salud A, Porcel JM, Tumor type influences the effectiveness of pleurodesis in malignant effusions. Lung 2011;189:151-5.  Back to cited text no. 6
    
7. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev 2004:CD002916.  Back to cited text no. 7
    
8. Benko I, Molnar TF, Horvath OP. Palliative treatment of malignant pleural effusions by video-assisted thoracoscopic surgery. Acta Chir Hung 1999;38:131-3.  Back to cited text no. 8
    
9. 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. 9
    
10. Tan C, Sedrakyan A, Browne J, Swift S, Treasure T. The evidence on the effectiveness of management for malignant pleural effusion: A systematic review. Eur J Cardiothorac Surg 2006;29:829-38.  Back to cited text no. 10
    
11. Antunes G, Neville E, Duffy J, Ali N. Pleural Diseases Group, Standards of Care Committee British Thoracic Society. BTS guidelines for the management of malignant pleural effusions. Thorax 2003;58:ii29-38.  Back to cited text no. 11
    
12. Kuzdzal J, Sladek K, Wasowski D, Soja J, Szlubowski A, Reifland A, et al. Talc powder vs doxycycline in the control of malignant pleural effusion: A prospective, randomized trial. Med Sci Monit 2003;9:PI54-9.  Back to cited text no. 12
    
13. Bilaceroglu S, Guo Y, Hawthorne ML, Zhu Z, Stathopoulos GT, Lane KB, et al. Oral forms of tetracycline and doxycycline are effective in producing pleurodesis. Chest 2005;128:3750-6.  Back to cited text no. 13
    
14. Dikensoy O, Zhu Z, Donnelly E, Stathopoulos GT, Lane KB, Light RW. Combination therapy with intrapleural doxycycline and talc in reduced doses is effective in producing pleurodesis in rabbits. Chest 2005;128:3735-42.  Back to cited text no. 14
    
15. Cerimagic Z, Guska S, Pilav I, Banjanovic B. The using doxycycline in procedure chemical pleurodesis of malignancy pleural effusion. Med Arh 2006;60:360-3.  Back to cited text no. 15
    
16. Porcel JM, Salud A, Nabal M, Vives M, Esquerda A, Rodriguez-Panadero F. Rapid pleurodesis with doxycycline through a small-bore catheter for the treatment of metastatic malignant effusions. Support Care Cancer 2006;14:475-8.  Back to cited text no. 16
    
17. Elpern EH, Krueger J, Kimsey J, Silver M. The technique of pleurodesis. J Crit Illn 1994;9:1105-10.  Back to cited text no. 17
    
18. Dryzer SR, Allen ML, Strange C, Sahn SA. A comparison of rotation and nonrotation in tetracycline pleurodesis. Chest 1993;104:1763-6.  Back to cited text no. 18
    
19. DiBardino DJ, Vanatta JM, Fagan SP, Awad SS. Acute respiratory failure after pleurodesis with doxycycline. Ann Thorac Surg 2002;74:257-8.  Back to cited text no. 19
    
20. Liao H, Guo Y, Jun Na M, Lane KB, Light RW. The short-term administration of Ketoprofen does not decrease the effect of Pleurodesis induced by talc or Doxycycline in rabbits. Respir Med 2007;101:963-8.  Back to cited text no. 20
    
21. Fyfe AJ, McKay P. Toxicities associated with bleomycin. J R Coll Physicians Edinb 2010;40:213-5.  Back to cited text no. 21
    
22. Heffner JE, Klein JS. Recent advances in the diagnosis and management of malignant pleural effusions. Mayo Clin Proc 2008;83:235-50.  Back to cited text no. 22
    
23. Bleomycin in malignant pleural effusion. Choose talc pleurodesis. Prescrire Int 2011;20:291.  Back to cited text no. 23
    
24. Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med 1994;120:56-64.  Back to cited text no. 24
    
25. Dikensoy O, Light RW. Alternative widely available, inexpensive agents for pleurodesis. Curr Opin Pulm Med 2005;11:340-4.  Back to cited text no. 25
Advanced Biomedical Research
Volume 2014, july
July 2014
Pages 1-5