Rapid Pleurodesis: Single Agent Single Session Vs. Multiple Sessions Using Multiple Agents in the Treatment of Recurrent Malignant Pleural Effusion

Abstract

Background: One prevalent, upsetting side effect of several oncological conditions is malignant pleural effusion. Pleurodesis is one of the most effective ways to reduce symptoms, stop recurrence, and enhance quality of life. This prospective study aimed at evaluating the performance of three rapid pleurodesis procedures and determine which modality achieved the most positive results, the fewest problems, and the most cost-efficiency.

Methods: This study included 91 patients with recurrent and rapidly collecting malignant pleural effusion. They were distributed into three groups: Group A (single session, single agent), Group B (single session, combined agents), and Group C (multiple sessions, multiple agents) pleurodesis through a catheter which was closed for 2 hours and then opened to drain. The catheter was then removed, and the patient was discharged to continue outpatient follow-up.

Results: Group A included 28 patients, Group B included 29 patients, and Group C included 34 patients. The most common primary malignancy was breast cancer in Group A (46.4 %), and lung cancer in Group B (48.3%) and Group C (47.1 %). Frequently encountered complications following pleurodesis were fever (7.1%, 10.3% and 11.8 % for group A, B and C respectively); and dyspnea (7.1 % in Group A), (13.8% in Group B), and (8.8% in Group C). Hospital stay was longer in the third group with (p<0.001) without significant difference in the outpatient follow-up for lung inflation and recurrence as in one week was (3.6 % in Group A), (0 % in Group B and Group C), in one month was (10.7 % in Group A), (6.9 % in Group B), and (2.9 % in Group C), in 3 months was (14.3 %  in Group A), (17.2 in Group B), and (11.8% in Group C).

Conclusion: Rapid pleurodesis – either with a single agent in a single session, a combined agent in a single session, or multiple sessions using multiple agents – is an effective treatment to avoid the recurrence of malignant pleural effusion with minimal side effects. Since the first protocol is equally successful and requires only a short hospital stay at a moderate cost, we recommend it.