Downloaded From: on 09/09/2014

Treatment
of Malignant
Khaled
Reshad,
M.D.;
Kenji
Shigeki
Hitomi,
M.D.,
F.C.C.P.t
Inui;
Pleural
Yoshiki
Takeuchi;
Yutaka
hundred
effusion
were
nant pleurisy
mesothelioma;
Adenocarcinoma
most frequent
The modalities
consecutive
patients
with malignant
pleural
reviewed.
The pathologic
etiology
of maligwas: primary
lung cancer
in 123 cases; five,
and 72 cases secondary
to metastatic
tumors.
of the lung and mammary
cancer were the
tumors
causing
malignant
pleural
effusion.
employed
in local treatment
consisted
of
thoracocentesis
in 62 patients,
tube thoracotomy
in ifi cases
with local instillation
of adriamycin,
MMC,
CQ, 5FU,
0K432
or talc. Surgical
procedures
including
pleuropneumonectomy
or reduction
surgery
of the tumor with decortication were performed
in ten patients.
Tube drainage
with
1.\vo
C
arcinomatous
pleurisy
is not uncommon
as a manifestation
ofcancer,
and often results in significant
pulmonary
and cardiac
insufficiency
threatening
the
life ofthe
fluid,
patient.
The
also
to prevent
and
sion. Despite
in use today,
this
cocentesis
Various
methods
recurrent
fluid,
or tube
injection
been
the
of effu-
such
to the
decortication,
advocated
multiple
drainage
agents,
Radiation
with
been
have
pleural
materials
tetracycline.
cotomy
is to remove
reaccumulation
including
of antineoplastic
sclerosing
and
treatment
the
the many
methods
tried in the past and
no single
method
of treatment
is entirely
satisfactory.
prevent
ideal
with
or without
radioactive
isotopes
as talc, quinacrine
chest wall, open
and
to
thora-
pleurectomy
This
report
with
presents
a review
a series
carcinomatous
of
pleurisy.
determine
the
The
effect
ofour
experience
consecutive
200
also
results
of therapy
were
and
thoracoinitial
results
were obtained
in patients
who received
reduction
surgery
with decortication
and pleurodesis.
Results
of
cytologic
investigation
were
positive
in 157 cases
(78.5
percent).
The tumor
cells disappeared
in 79.4 percent
of
primary
cancer
pleurisy
cases and 8L1 percent
of patients
with metastases
while disappearance
or significant
decrease
in pleural
effusion following
treatment
was obtained
in 75.2
and 77.8 percent
respectively.
The median
survival
was 11.3
months
in primary
cases, and 11.7 months
in patients
with
for malignant
ofMalignant
Diagnosis
The
film,
diagnosis
analyzed
to
its significance
in
chest
computed
METHODS
Pleurisy
of malignant
pleurisy
tomography,
was
and
provided
cytologic
by chest
examinations
x-ray
of the
pleural
fluid obtained
by initial thoracocentesis.
More invasive
diagnostic
procedures
such as needle biopsy, pleuroscopy
or pleural
biopsy during open drainage
and decortication
were performed
in
patients
with
several
negative
cytologic
investigations
of pleural
efflisions.
The
records
Denryoku
of
consecutive
Tenri
Hospital
Hospital,
Shimada
City,
tChest
Diseases
Research
Japan.
Institute,
*From
Manuscript
Reprint
Hospital,
Hospital,
200
the
Department
of
Chest
and
patients
treated
Shimada
Municipal
Diseases,
Kyoto
Shimada
University,
at
without
pleural
effusion
more
was
local
effective
therapy.
than
Excellent
betweenJanuary,
were reviewed
in this series.
There were 1.23 malignant
pleural
1975
and
December,
due
to primary
1983
cancer
with
85 years.
patients
an average
patient
Seventy-six
had
patients
bilateral
effusions
67.8
years
were
men
malignant
ofage,
and
pleural
lung
from 32 to
ranging
47 were
effusion;
women.
65 had
Nine
right
sided,
and 49 had left sided hemithorax.
The histologic
distribution
ofprimary
lung cancer
causing malignant pleural effusion is listed in Table 1. Malignant
pleurisy
secondary
to metastatic
tumors
ofwhich
and
29 were
Their
The
listed
average
age
pathologic
in Table
mesothelioma
right-sided,
was
involved
53 years,
etiology
52 women
32 left-sided
with
of metastatic
and
and 16 bilateral
the
range
malignant
13 to 84
pleurisy
is
2.
A variety
of modalities
was employed
in local treatment
of
malignant
pleural effusion.
They
included
thoracocentesis
or tube
intercostal
drainage
with or without
instillation
of antineoplastic
drugs, sclerosing
agents,
and surgical
procedures
such as pleuropatients,
(llsble
four
drainage
therapy.
included
and
AND
or
metastases.
partial
MATERIAL
of drugs
with
pneumonectomy
with
prognosis.
CLINICAL
and
instillation
centesis
years.
since
patients
local
pleurisy.
described.
1975
Takahashi;
25 men,
and
thora-
have
Effusion*
times
Thoracocentesis
patient
on
was
average,
resection
of the
pleurodesis
in
therapy
instillation
was
local therapy.
The drugs
primary
performed
instilled
adriamycin
as
tube
site
of the
tumor
in 16 patients
in
62
intercostal
into the pleural
(20 mg),
cavity
mitomycin
materials.
These
or in combination,
injected
into the pleural
singly
agents
were
local
of rejection
during
of the
tube
drainage
5FU
(500
drugs;
OK432(10
talc or tetracycline
selected
in 20 ml
through
effusion.
without
C (10 to 20 mg),
dissolved
cavity
decortication
pleural
because
(10 mg) as antineoplastic
immunotherapeutic
agent
and
an
sclerosing
with
six patients
with
malignant
with a systemic
chemotherapy
and carbazilquinone
KE)
applied
and
was performed
in 111 cases with an average of 16 days of
Ten patients
were subjected
to surgical procedures
which
pleuropneumonectomy
in four cases,
and lobectomy
or
Palliative
were
3).
per
randomly
of saline
a chest
tube
and
solution
which
mg)
to 20
as
used
and
was then
Kansai
Table
Hospital
Municipal
Kyoto,
Japan.
received
November
19; revision accepted
February
26.
requests:
Di Reshad,
1200-5 Noda,
Shima
Municipal
Shimada
City, Shizuoka,
Japan 427
1-Histology
(Primary
Adeno
car
Sqcellcar
Large
cell
car
ofCarcinomatous
Lung
123
Cases)
71
Small
24
Alvcellcar
7
CHEST
Downloaded From: http://journal.publications.chestnet.org/ on 09/09/2014
Cancer,
Pleurisy
cell car
6
5
Others
I
88
I
3 I SEPTEMBER,
10
1985
393
Table
2-Histology
Pleurisy
ofCarcinomatous
and Mesothelioma
M#{233}tastatic Tumors
25
Thyroid
Castroint
t
Utero-ovar
t
Mal Lymph
22
Sarcomas
MalThym
4-Treatment
Carcinomatous
Effectiveness
Pleurisy
in
(77 Cases)
c
Mammary
Table
t
Disappearance
Tumor cells
3
2
6
Kidney
5
Others
t
2
2
5
Mesoth
5
Primary
of
in
Decrease
of
Survival
lime
P1 Fluid
P1 Fluid
(Months)
79.4%
75.2%
11.3
81. 1%
77.8%
11.7
Ca
Pleurisy
Metastatic
Table
Palliative
3-Treatment
Pleurisy
ofCarcinomatous
therapy
Thoracocenteses
Pleurisy
17 Cases
local
instillation
62 Cases
peutic
4.
agent
(Av 4 times/pt)
Tube
thoracostomy
111 Cases
10 Cases
operation
clamped
for two hours. The patients
position
was varied every few
to ensure
the contact of the drugs over the entire pleural
minutes
cavity.
The
chest
tube
was reconnected
under
and 15 cm of constant
water
suction
drainage
tube was removed
when
the
cated full reexpansion
of the lungs. In
through
the chest tube was performed
time
for removal
ofthe
was
water-sealed
used.
chest
effusion.
intercostal
roentgenograms
lung
mdi-
Results
of
investigation
effusion
showed
that
157 of
positive
for tumor
cells (78.5
of the pleura
was performed
with
12 positive
results
(55.
results
of cytologic
investigations
pleuroscopy
was
and
performed
Disappearance
ofrumor
Effusion
The
with
results
Survival
oftreatment
the
pleural
needle
in nine
eight
positive
pleural
biopsies;
surgical
procedures
was performed
positive
of
open
and
with
biopsy
during
in ten cases with
Control
in Relation
in 183 patients
Table 5-Treatment
the
drugs
50 percent
was
did
Effectiveness
antineoplastic
to treat malignant
have
ability
those
responding
in patients
with
lesions
(p<O.O1).
85)
in
specific
to cause
space,
doses.
chest
drugs
have
been
pleural
effusion.
antitumor
pleural
activity
sclerosis
and
doses
used were the
A local combination
tube drainage
provided
and
Survival
Time
used
in
Although
and
also
obliterasame as
chemoin 103
(Chemotherapy)
LC
in Metastatic
Pleurisy
(%)
Survival
lime
(n
local
cancer
secondary
Time
Survival
Number
metato
in primary
Survival
of
and
Agents
(%)
Pleurisy
primary
on average
and
Various
attempts
instillation
cases.
received
in Primary
of
to Instilled
drugs
pleural
chemother-
local
in both
Relation
the
receive
to metastatic
tion of the pleural
the usual systemic
therapy
along with
to Treatment
Effectiveness
due
metastatic
ofsystemic
not
was 11.3 months
and 11. 7 months
these
of Pleural
who
of pleural
evaluated
as
of 183 primary
and
the effectiveness
who
Treatment
biopsy
cases
in Table
to therapy.
in patients
have
Time
thirty-seven
apy
pleurisies
results.
Cells
responded
therapy
patients,
the 200 effusions
were
percent).
Needle
biopsy
22 times
in 18 patients
5 percent).
When
the
failed,
100 percent
hundred
static pleural
patients.
The
survival
time
Investigations
cytologic
decrease
weeks
was
mesothelioma
In contrast,
drain.
of Cytologic
One
cancer,
effusions
some cases, thoracography
to evaluate
the appropriate
RESULTS
Results
immunothera-
are listed
effective
treatment
according
to the Japan
Lung
Cancer Society.
In our protocol,
significant
decrease
constitutes
a 75 percent
decrement
in treated
pleural
drainage,
The
drugs,
materials
Disappearance
or significant
fluid stable
fur more than four
(Av 16 days/pt)
Surgical
ofantineoplastic
or sclerosing
(Months)
Number
(n
=
55)
lime
(Months)
Systemic
Chemotherapy
Systemic
Only
9
50.0
3.9
7
50.0
4.0
28
18
4
4
79.0
67.7
85.0
75.0
14.8
7.8
10.6
9.5
15
10
4
5
90.0
12.8
19
85.0
14.0
3
80.0
12.0
Chemoth.
+
Local Chemoth.
MMC
ADM
MMC+ADM
MMC+5FU
CQ+5FU
Others
394
Downloaded From: http://journal.publications.chestnet.org/ on 09/09/2014
75.0
5.0
60.0
10.0
8
95.0
100.0
11.2
10.3
6
80.0
13.5
Treatment of Malignant Pleural Effusion (Reshad
et a!)
Table
6-Treatment
Effectiveness
and
Survival
Time
(Chemotherapy
+ Immunotherapy)
u:
in Primary
Pleurisy
in Metastatic
(%)
Pleurisy
(%)
Survival
Number
.
(n
Survival
lime
=
38)
(Months)
Number
(n
lime
=
(Months)
21)
MMC+OK432
16
83.4
12.2
9
71.5
12.0
ADM+OK432
10
55.0
6.2
5
75.0
7.0
3
67.0
8.0
MMC+ADM
+0K432
2
75.0
7.5
+OK432
4
90.0
9.8
1
88.0
11.3
6
67.7
4.5
3
67.7
5.0
Others
OK432
Table
5 shows
vival time ofl4O
drugs
by
those
who
local
the treatment
patients,
who
local
instillation
received
instillation
was
drugs
by
compared
cancers
and
with
without
ofprimary
successful
instillation
in combination
85 to 100 percent
significant
two groups
resingly
Treatment
was obtained
of primary
effusions,
respec-
The
type
median
months
months
survival
ranged
in pleurisy
of primary
in cases with metastases.
In
contrast,
percent
the
with
periods
3.9
in patients
apy only.
The
No
who
received
in survival
(5)
67
Sguanoa
to 14.8
shown
and
5.0
to 13.5
adenocarcinoma
chemotherapeutics,
was
median
systemic
time
between
of
FIud
Swv,,.I
T.,oo
72
ca
::
Large
Small
cell
ca
cell
Ca,
Alveolar
Ofh.,s
5
0
1
0
3
0
Musofit
5
IIS
74.0
83.0
83.0
: :
: ::
fstoIogy
C
(Monfhs)
?
of
-
23
Gtro-InfL
I.
u1.,o-.r.
t
20
,
oo .o
80
.0
:‘
75.2
f.
3
primary
instillation
or sclerosing
of
pleural
fluid
becom-
(73.5
percent)
and
pleural
(72 percent).
The
P
FId
(%)
85
.0
82.0
Sun,,val
Tims
5
10
15
2O
survival
time
.0
73.5
(pri-
.0
50.0
:
67 7
!iii
-:--
50.0
50.0
FIGURE
(metastatic
.
50
-;SS
2.
.0
-:---
50.0
: ::
81
.0
Effectiveness
of
tumors,
65 patients).
SSN1
50.0
50.0
1
77.8
local
treatment
and
CHEST I 88 I 3 I SEPTEMBER,
Downloaded From: http://journal.publications.chestnet.org/ on 09/09/2014
(Monff)
.
I.
Total
time
85
50
0th.,.
survival
cases).
(%)CII,,
-:-
Lh.
K.
and
five
is
with
in the
in 48 patients
80
Swcanu
.7
patients
20
M.t Th
67
to tumor
methothelioma
D_Pfrt#{149}n
s.o
Munnry :
intra-
f.
.7
cells
disappearing
c__
.0
1. Effectiveness
of local treatment
cancer,
113 cases;
mesothelioma,
lung
tumor
No
a sys-
100.0
67
in
local
Thyroid
1
!_
._:
Toi.I
0
77.0
Time
a
these
according
and
seven
in 49 patients
D.cr
Pt
Survival
cancer
1. Sixty
showed
was also
between
treated
with
local
immunotherapeutic
negative
effusion
019
24
cell
agents
ing
chemother-
10
::
50
survival
time
treatment
lung
in Figure
7.8
those
who received
only
was significant
(p<O.00l).
treatment
according
to
D,sp#{149}tancs
of
Too,o,
Cells
of
months
to local
primary
from
effectiveness
4.0
to
c!!
Adsooca,.
treatment
and
P4stoIogy
cancer
and
difference
treated
pleurisy
temic
chemotherapy
The
response
FIGURE
period
improve-
there
Type
response
in
and
whose
tumor.
better
alone,
in survival
to Tumor
55 to 90
metastatic
showed
Effectiveness
Relation
to
instilled
difference
(p<0.01).
is
in
in 21 patients
secondary
OK432
agents
agents
from
varied
percent
combinations
than
of these
patients
to 88
was
all
rates
effectiveness
cancer
67
effusion
of
(p<O.Ol).
The
lung
ment
anti-
6. The
and
pleurisy
therapeutic
of MMC
pleural
primary
Although
cancer
ofmetastatic
chemoimmunotherapeutic
in Table
pleural
instillation
metastatic
instilled
shown
percent
(16 cases).
intrapleural
and CQ plus 5FU therapy
in 79 to 90 percent
and
mary
38
in 75 to 100 percent
neoplastic
agents.
More
sponse
with
intrapleural
tively
cases),
chemotherapy
in 67 to 85 percent
and
obtained
lung
pleurally
(124
systemic
of the
Improvement
patients
effectiveness
and surreceived
antineoplastic
1985
395
0
50
Ag.
Survn#{149}I
(v.0.)
S
$2
Pisuro
LC
0
7.
6
‘9
0
10
Tuv
19
(tne.)
20
25
30
35
It
t
Ad
-
Pnitrt
MPt
0
$7
mesothelioma
One
patient
denly
one
and
three
months
month
after
0
two to
last
patient
pleurodesis
subjected
to
lobectomy
and
surgery.
after
of malignant
pleural
SSSSSt
0
S
The
were
C
surface
cotomy
R
two patients
operation.
of this high mortwo patients
Mitomycin
Pati.
the
undersud-
died
survived
for eight
months.
Because
tality
rate after pleuro-pneumonectomy,
recurrence
LC
S.
surgery,
after
ten and 24 months
after
six, ten, 18, 36 months
S
Moth
+
PI#{149}ursd #{149}
and one with malignant
pleuropneumonectomy.
after
decortication
ofthe
pleura,
and four patients
to partial
resection
of the tumor
with pleurodesis.
Two patients
who received
partial
resection
with pleurodesis
died
Ad
Lob.ct
cancer
went
effusion
and
was
to prevent
Four patients
this procedure
are alive
with
no
(Fig 3).
OK432
insufflation
per!brmed
during
the recurrence
over
the
open
thora-
of malignant
pleural
effusion.
Ad
DISCUSSION
PIured.
::#{149}
#{149}
.7
Drugs
IrIiod
t
MMC
Infvapl,ueaIly
10
01(432
3. Surgical
FIGURE
effectiveness
of tumor
was
83
percent
tively.
0
mg
20
kE
percent
in
pleurisy.
shown
in other
The mean
large
cell
types ofpnmary
survival
time
the
venous
by disappearance
of pleural
fluid
cell carcinoma,
carcinoma,
and
malignancies
was 17 months
tive
effusion
continued
tumor
fluid.
cells
On
tumors.
in pleural
the
effusion
whole,
the
time
Surgical
Effusion
was
11.7
Procedures
in
has been
with
empyema
tion or secondary
20 percent
of the
from
this
malignant
procedure
pleural
cells
and
heart
cases
after
of the
patients
the
the mean
Pleural
shown
malignant
after other
air leakage,
decreased
pulmonary
failure
complicated
postoperatively,
is also
effusion,
leads
to
trolled
func-
of
and
patients
with
with
primary
lung
Downloaded From: http://journal.publications.chestnet.org/ on 09/09/2014
malignant
advocated
for
Each therapy
has
so it is difficult
depletion,
high
Tube
with
is
risk
thoracotomy
especially
agents,
Sayenk’
malignant
a much
reported
pleural
cotomy
has
success
in 90 percent
such
been
of
with
instillation
more
of
effective
Pugh,4
and
by
Nitrogen
and
Jones5
Treatment
initial
have
reported
used
most
effusion.
of pleural
been
pleural
effuet al,3 Borja
success-
instillation
has been
tumors,
results
of talc
thora-
sclerosing
tetracycline
and
malignant
control
metastatic
successful
conat the
with
Other
of malignant
results.
Rocklin
quinacrine
mustard
powder
intruded
Jones2
of patients.
Hickman
with
talc
when
Also,
insufflation
surface
through
a tube
as quinacrine
ful treatment
pleurally.
that
effusion
described
various
achieved
Four
three
to effec-
often
is most beneficial
to the
accepted
that repeated
to other
forms
of therapy
etc.
evacuation,
types
the treatment
of
reported
complete
high.
too
therapies
protein
time
of open
thoracotomy.
powder
over the pleural
and
of
mechanisms.
respond
effusion.
and mortality,
lung,
more than
and mortality
396
but
administered
for treatment
sion with good to excellent
effusion
methods
bleeding,
pleural
method.
agents
to be highly
pleural
usual
may
to be various
trapped
Adler
in 54
the
which
therapy
is now generally
is inferior
it
different
of pleural
disappeared
Malignant
who experienced
recurrences
treatment.
However,
persistent
pneumonia,
decrease
and in 49 of65
or decreased;
Against
patients
survival
months.
Pleuropneumonectomy
effective
median
was 18. 2 months
disappearance
and
tumor
of65 patients
(81. 1 percent),
pleural
effusion
disappeared
survival
The
cancer
patients
with 85 percent
because
infection,
to 70
illness.
intractable.
continue
the treatment
ofmalignant
some level of morbidity
respecin small
50
of the
invasion
of the pleura
of lymphatic
and
effusion
chemotherapy,
remains
There
67.7
complica-
in
of malignant
probably
pleural
systemic
secondary
to metastatic
is a common
occurring
the course
pathogenesis
are
malignant
to determine
patient.
It
thoracocentesis
in 23 breast
instillation,
exact
channels
Some
cell carcinoma,
with
the longest
survival
time
58
months.
The mean
survival
time was 11.3 months
on
average
in all patients
with primary
cancer
pleurisy.
Figure
2 shows the effectiveness
and survival
of local
instillation
ofdrugs
in 65 patients
with pleural
effusion
time
drug
effusion
malignant
diseases,
of all cancers
in
effusion
is often obscure,
direct
by tumor
cells and obstruction
for carcinomatous
treatment
pleural
Although
20
cells and significant
decrease
and 74 percent
in squamous
77
both
therapy
ofthe
tion
of
percent
.
Ld
3
Malignant
intra-
frequently
Kinsey
effusion
in
et al6
from
and
Leininger
et al7
in 90 percent
of patients
of Malignant
Pleural
Effusion
(Aeshad
et a!)
with
the
instillation
pleural
space
through
of nitrogen
mustard
a tube thoracotomy,
but
into
the
Ander-
son and coworkers8
obtained
poor response
with intracavitary
administration
of this drug in lymphomatous pleurisy.
Adriamycin,
mycin
several
carbazilquinone,
and 5FU
authors
excellent.
cadia CWS
were
been
was
in
Immunotherapeutic
or OK432
were
15 out
Norcadia
reported
27 months
when
reported
were obtained
series,
these
of 18
CWS
and
cavity
percent
malignant
than
this
the
improvement
given
with
after
other
methods
the
obtained
in up to 90 percent
sies and
up to 100 percent
and
received
chest
drainage
with
were
cancer
pleuritumors,
who
local
therapy.
obliteration
the
delay
We obtained
resection
sion patients
ineffective,
definitive
pleural
effusion,
was frequently
excellent
with
a majority
who
failed
trapped
to have
lung
the responsible
initial
pleurodesis
in whom
but when
for
patients
results
of patients
due
pleural
methods
is too radical
with
may
Also,
to effusion
pulmonary
protein
possibly
a careful
or treatment
function,
depletion
or infection
ofmalignant
and
pleural
talc.
effusion:
Thor
Ann
Surg
A
1976;
‘freatment
ofrecurrent
Thorax
1969;
Smart
CR,
DB,
malignant
Gynecol
pleural
Wagner
DE,
effusions
Obstet
effusion
by iodized
talc
24:69-76
using
1964;
Silvia
ARM.
quinacrine
Control
of
hydrochloride.
118:991-94
local
instillation
of quinacrine
(Mepacrine)
hydrochloride.
1970; 25:226-29
6 Kinsey DL, Klassen
KP, Carter
D. Simplified
management
of
malignant
pleural effusion.
Arch Surg 1964; 89:389-92
7 Leininger
BJ, Barker WL, Langston
NT A simplified
method
for
management
of malignant
pleural effusion.
J Thorac Cardiovasc
Surg 1969; 58:758-63
8 Anderson
CB,
malignant
9 Ohta
Philpott
effusions.
M.
GW,
Cancer
Treatment
10 Leff A, Hopewell
nancy, Ann Intern
11
Ferguson
1974;
TB.
The
treatment
of
33:916-22
of pleural
effusion.
Geka
to
lung
1982;
MOOK
K,
Kitano
M,
Hitomi
N, Bans
MS.
Beattie
S. Treatment
malig-
Indications
agents.
Jap J
for pleurectomy
1975; 35:734-38
K, Shinkai
T, Shimizu
E, Shibuya
14 Nagao
special
K.
trial using NCWS in treatment
of malignant
Gann to Kagakuryoho
1983; 10:290-95
Studies
on treatment
of pleural
cinomatosis,
with
reference
to
effect
of
0K432.
Chiba
Med
J
1982;
58:345-53
15 Ohta K, Oyama A, Kurita
5, Nishimura
M, Ogawa
M, Kamei
Y.
Effect ofhemolytic
streptococcal
preparation
OK432
on pleuritis
and peritonitis
carcinomatosa.
Gann
to Kagakuryoho
1980;
2:255-65
16
Egawa
malignant
17
N, Meguro
Izbicki
R, Weihing
Pleural
effusion
18 Takagi
T Local
efflisions.
K. Cases
pneumonectomy.
instillation
Shindan
BT,
in cancer
ofpleural
Japan
to Shinyaku
of0K432
1982;
in treatment
of
19:201-04
Caoili EM, Vautkevicius
VK.
Cancer
1975; 36: 1511-18
carcinomatosis
undergoing
panpleuroJ Lung Cancer
1981; 21:161-75
Baker
L,
patients.
CHEST I 88 I 3 I
Downloaded From: http://journal.publications.chestnet.org/ on 09/09/2014
from
of carcinomatous
of anticancer
EJJr.
in malignant
effusion.
Cancer
Saijo N, Eguchi
K, Tominaga
effusion
A. A randomized
pleural
effusion.
effuwere
and
malignant
Reshad
PC, Costello
J. Pleural
Med 1978; 88:532-37
pleurisy
and pleural
permeability
Lung Can 1982; 22:139-51
reason.
in definite
in malignant
other
treatment
this procedure
which
cases.
4 Borja RR, Pugh RE Single dose quinacrmne (Atabrine)and
thoracotomy
in the control
of pleural
effusions
in patients
with
neoplastic
diseases.
Cancer 1973; 31:899-902
5 Hickman
JA, Jones MC. Treatment
ofneoplastic
pleural
effusions
13
instillation
of M MC combined
with
and CQ plus 5FU.
Also, we achieved
successful
results
in most
of the patients
who had a
short interval
between
diagnosis
and local therapy.
In
of the
GR.
12 Martini
with intrapleural
any other
agent
in most
of
instillation
of antiagents
in treatment
be performed.
3 Rocklin
Multi-
ple
drug
instillation
into
pleural
space
was
more
effective
in obliterating
pleural
fluid than single
agent
instillation.
There
was a high response
rate obtained
contrast,
we recomconsisting
25:114-21
complications.
treatment
results
of primary
in metastatic
the method
effective
with
action
local
to
mostly
Thorax
results
in 90 percent,
but the mormethod
is about
10 to 20 percent
for the
high incidence
of postoperative
In our
series,
successful
is
22:8-15
with
pleural
of treatment,
approach
effusion
effusion,
in subacute
failure,
where
Consequently,
1 Adler RH, Sayenk
I. Treatment
method
using
tube
thoracotomy
Surg
stalL
to be a highly
malignant
general
immediate
contributing
as decreasing
heart
should
recurrent
with
with
in
the
mortality.
and
search
for factors
of effusion
such
pleurodesis.
in 30 to
intrapleurally
patients
and
situations
of the symptoms,
should
be highly
of malignant
pleural
prevent
trapped
lung
pleural
of patients
controlled
hazard
to hospital
has been shown
for
tube
for alleviation
for treatment
aggressive
for
failed.
pleural
chest
tube
drainage
and
neoplastic
or immunotherapeutic
successful
from
therapy
mend
kept
since
malignant
low morbidity
in
in properly
selected
patients.’8
Martini
et al’s
this procedure
in patients
who had recurrent
effusion
palliative
selected
be
have
REFERENCES
results
in our
However,
the use of radioactive
in ordinary
hospitals
and may
a radiation
obtained
tality
into
percent
were
that,
of
in patients
period
isotopes
P
Pleuropneumonectomy
pleural
survival
Sixty
effusion
and
efl#{232}ctive treatment
for
treatment
ofthe
patients
to give
study by Izbicki et
isotopes
is not available
constitute
instilled
conclude
secondary
period
survived
We
treatment
2 Jones
reported
drainage
who
have
survival
case
was locally
median
of cases.
pleural
90
efluision
per!brmed
median
Nagao.’4
Successful
in up to 90 percent
been
by
to
et al’s and
results
ob-
(83 percent),
intrapleurally
effective
of radioactive
has
pleural
The
most
with a longer
reports.
Instillation
Ohta
initial
patients
instilled
‘
the
0K432
by
as
bleo-
agents
such
as Norinstilled
via the intracavi-
al,’3 Nagao,’4
Successful
by Saijo.
six months
C,
instilled
into the pleural
cavity
with
results
varying
from
good
tary route
by Saijo et
Egawa
and
Meguro.’6
tamed
received
mitomycin
pleural
effusion,
it should
conservative
approaches
SEPTEMBER,
1985
397