Comparison of the effectiveness of some pleural sclerosing agents used for control of effusions in malignant pleural mesothelioma: a review of 117 cases

Our plain-English summary of Comparison of the effectiveness of some pleural sclerosing agents used for control of effusions in malignant pleural mesothelioma: a review of 117 cases, by A. Senyiğit, H. Bayram, C. Babayiğit, et al (Respiration; International Review of Thoracic Diseases, 2000).

The study

• Authors: A. Senyiğit, H. Bayram, C. Babayiğit, F. Topçu, A.E. Balci, O. Satici
• Journal: Respiration; International Review of Thoracic Diseases
• Published: 2000;67(6):623-9
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Objectives: Management of malignant pleural mesothelioma (MPM) has been an important clinical issue regardless of the treatment modality employed. We aimed to investigate the efficacy of oxytetracycline (OT), Corynebacterium parvum (CP), and nitrogen mustard (NM) in the management of pleural effusion associated with MPM.

Methods: One hundred and seventeen patients who had stage-2 MPM or over according to the Butchart staging system and unilateral or bilateral pleural effusion took part in the study. The patients received either OT (35 mg/kg), CP (7 mg), or NM (0.4 mg/kg) through a chest tube for pleurodesis. The association between several clinical parameters and patient survival was also investigated.

Results: OT was applied to 59, CP to 29 and NM to 29 cases. A statistical analysis of the results obtained by these agents have demonstrated that OT (30 days, 81%; 90 days, 76.2%) and CP (30 days, 86.2%; 90 days, 79.3%) led to a significantly higher rate of successful pleurodesis as compared to NM (30 days, 48.2%; 90 days, 41.3%; p <0.05). Although the procedure was generally well tolerated by the patients, the NM-treated group experienced significantly more nausea-vomiting (46.1%) and hypotension (35.8%) compared to patients who received OT (nausea-vomiting and hypotension 4.3%; p < 0.001) and CP (nausea-vomiting and hypotension 5.1%; p < 0.001). Furthermore, we found that thrombocytosis, chest pain and weight loss were significantly associated with poor prognosis, whereas epithelial type had a positive effect on survival.

Conclusion: These results suggest that OT and CP may be used as effective sclerosing agents for pleurodesis in the control of pleural effusions associated with MPM, without major side effects.

Copyright 2000 S. Karger AG, Basel

In plain English

This study from Diyarbakır, Turkey, compared three drugs instilled through a chest tube to seal the pleural space (pleurodesis) and stop fluid recurring around the lung in malignant pleural mesothelioma. Of 138 consecutively entered patients with Butchart stage 2 or higher disease and pleural effusion, 21 were excluded, leaving 117 (67 men, 50 women). Patients received oxytetracycline (59 patients), Corynebacterium parvum (29) or nitrogen mustard (29). At 90 days, pleurodesis had succeeded in 76.2% of oxytetracycline patients, 79.3% of Corynebacterium parvum patients and 41.3% of nitrogen mustard patients, a significantly lower rate for nitrogen mustard. Nausea-vomiting followed 46.1% and low blood pressure 35.8% of the 39 nitrogen mustard procedures, significantly more often than with the other drugs. Longer average survival was associated with the epithelial subtype and with no thrombocytosis, chest pain or weight loss. Average survival by drug (11, 10 and 9 months) did not differ significantly. In all, 104 patients died during the study. The authors concluded that oxytetracycline and Corynebacterium parvum can be used as effective agents without major side effects.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Clinical case series comparing three pleurodesis (sclerosing) agents in consecutively entered patients. The title calls it 'a review of 117 cases', but it reports the authors' own patients, not a literature review.
• Who was studied: 138 patients were screened and entered and 21 were excluded, leaving 117 patients with malignant pleural mesothelioma (Butchart stage 2 or higher) and pleural effusion. They were 67 men and 50 women, with a median age of 53 (range 24 to 79). Patients were seen in the Departments of Chest Diseases or Thoracic Surgery, University of Dicle, Diyarbakır, Turkey, between January 1992 and December 1998.
• Exposure: Asbestos exposure was not assessed. The 'exposure' was the treatment, instilled through a chest tube: oxytetracycline (35 mg/kg), Corynebacterium parvum (7 mg) or nitrogen mustard (0.4 mg/kg). There were 69, 39 and 39 procedures respectively, 147 in total including repeat procedures.
• Main results:
  • Oxytetracycline group (59 patients): successful pleurodesis in 81% at 30 days and 76.2% at 90 days.
  • Corynebacterium parvum group (29 patients): successful pleurodesis in 86.2% at 30 days and 79.3% at 90 days.
  • Nitrogen mustard group (29 patients): a significantly lower success rate than the other two agents (p less than 0.05), at 48.2% at 30 days and 41.3% at 90 days.
  • Including repeat procedures, the overall success rate was 79.7% for oxytetracycline and 84.6% for Corynebacterium parvum. Nitrogen mustard was lowest, at 41%. Pleurodesis succeeded in 97 of 147 procedures (65.9%).
  • Side effects were counted per procedure. Nitrogen mustard procedures (39) had significantly more nausea-vomiting (46.1%) and hypotension (35.8%) than oxytetracycline procedures (69; 4.3% each) and Corynebacterium parvum procedures (39; 5.1% each), with p less than 0.001 for both comparisons.
  • Oxytetracycline caused severe or life-threatening adverse effects in 2 patients. No death was associated with pleurodesis.
  • Bronchopleural fistula, which developed as a result of lung laceration, occurred in 19.5% across the study. The authors described this rate as remarkably high.
  • Mean survival was significantly longer for epithelial type mesothelioma (14.1 months) than for sarcomatous (8.8 months) or mixed (9.8 months) types (p less than 0.05).
  • Mean survival was longer in patients without each of these features than in patients with it, with p less than 0.05 for each: thrombocytosis (13 vs. 8.7 months), chest pain (13.4 vs. 8.9 months) and weight loss (13.2 vs. 9 months).
  • Mean survival was 11 months with oxytetracycline, 10 months with Corynebacterium parvum and 9 months with nitrogen mustard. The authors reported no significant difference between the three groups.
  • 104 patients died during the study period: 26 nitrogen mustard patients (89.6%), 29 Corynebacterium parvum patients (100%) and 49 oxytetracycline patients (83%).
• The authors' conclusion: The authors concluded that oxytetracycline and Corynebacterium parvum can be used as effective sclerosing agents for pleurodesis to control pleural effusions in malignant pleural mesothelioma, without major side effects.
• Limitations the authors state:
  • The authors noted there were no clear data on the right dose of oxytetracycline for pleurodesis, and that their 35 mg/kg dose was higher than reported tetracycline doses. They called for further studies of its effect and optimum dose.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleural Effusion, Butchart Staging System, Bilateral, Pleurodesis, Prognosis.

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