Chemical pleurodesis for malignant pleural effusion: which agent is perfect?

Abstract
Background
Pleurodesis is defined as symphysis between two layers of pleura to prevent recurrence of effusion, and it is the best available treatment for recurrent effusions of incurable malignancies. An ideal agent must be highly effective, safe, inexpensive, and readily available which is yet to be identified.
The aim of this study was to assess our results of medical pleurodesis, using 3 different chemical agents: bleomycin ampoules, doxycycline capsules, povidone–iodine solution, through two different routes, chest tube and small bore indwelling catheter.
Over a period of 5 years, 104 patients with malignant recurrent pleural effusion underwent pleurodesis at our university hospital, using 3 different agents and two routes of delivery.

Results
Fifty patients were male, patients’ age ranged from 22 to 74 years (57.55 ± 9.02). Fifty-nine patients (56.7%) had right-sided effusion, 61 patients (58.7%) had massive effusion. All patients were dyspneic. The rout of effusion drainage and sclerosing agent instillation was chest tube in 64 patients (61.5%) and small indwelling catheter in 40 patients. Forty-three patients received bleomycin, 36 patients received doxycycline, and 25 patients received povidone–iodine. The total success rate was 78.8%.

Conclusion
Pleurodesis is a safe acceptable palliative procedure for malignant pleural effusion with not yet definite ideal agent or rout. Hence, the availability and the expense of agent are important.