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Management of Malignancy-Associated Pleural Effusion

Current and Future Treatment Strategies

  • Review Article
  • Published:
American Journal of Respiratory Medicine

Abstract

Management of recurrent malignant pleural effusion, a common complication of malignancy, poses a challenge to clinicians. Although almost one century has elapsed since the introduction of the pleurodesis procedure, the ideal approach and best agent are still to be defined. Optimally, pleurodesis should be done at the bedside with a minimally invasive procedure, and suitable agents to achieve pleural symphysis should be inexpensive, available worldwide and free of adverse effects. To date, no substance completely fulfills these requirements.

Silver nitrate should be considered for pleurodesis because of its low cost and ease of handling. Although talc has been used most frequently to induce pleurodesis, reports of death due to acute respiratory failure have raised concerns about the safety of this agent. Tetracycline, an effective alternative used in the past, is no longer commercially available. This agent has been substituted with derivatives of tetracycline, such as minocycline and doxycycline with success rates similar to those with tetracycline. Several antineoplastic agents have been injected into the pleural space with the aim of producing pleural symphysis, the most representative of this group being bleomycin.

Recent knowledge of the molecular mechanisms involved in pleural inflammation has brought into focus new substances, such as transforming growth factor β and vascular endothelial growth factor, which may be used as pleurodesis agents in the future. Nevertheless, more studies are necessary to better define the potential of these substances in the induction of pleural symphysis.

Ideally, a sclerosing agent should be cost-effective, available worldwide and easily administered. Talc will probably stand as the preferred agent to be used for pleurodesis in malignant pleural effusion because of its efficacy, easy manipulation and handling. However, further investigation is necessary to minimize adverse effects related to talc.

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Acknowledgements

This review was supported by FAPESP and CNPq (Brazil). The authors have provided no information on conflicts of interest directly relevant to the content of this review.

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  1. Pleura Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

    Evaldo Marchi, Lisete R. Teixeira &  Francisco S. Vargas

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  1. Evaldo Marchi
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Correspondence to Francisco S. Vargas.

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Marchi, E., Teixeira, L.R. & Vargas, F.S. Management of Malignancy-Associated Pleural Effusion. Am J Respir Med 2, 261–273 (2003). https://doi.org/10.1007/BF03256654

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