A New Approach in Patients with Malignant Pleural Effusions

Abstract

The efficacy of intracavitary fibrin sealant in preventing the recurrence of malignant pleural effusions was assessed in the present study. From 1982 to 1984 30 patients with cytologically and/or histologically proven malignant pleural effusions were treated by fibrin pleurodesis. The median age was 58 years (26–83 years). Chest tube drainage was carried out as completely as possible, confirmed by chest X-ray, and then was followed by administration of 20 000 U aprotinin to decrease fibrinolytic activity. The sealant solution, mainly containing fibrinogen, factor XIII, fibronectin and albumin, was injected into the pleural space through the tube in a dose of 10 ml, promptly followed by the thrombin solution (500 U/ml). The chest tube was removed 24 h after the instillation.

Twenty-seven patients were evaluated. The overall response rate after 30 days was 77% (21/27) with 70% complete responders and 7% partial responders. The toxic side effects were minimal. Fibrin pleurodesis was painless in all patients. In 10% (3/30) of the patients mild fever was observed 1–3 days after the instillation of fibrin sealant.

We conclude that fibrin pleurodesis, shortening the pathophysiological pathway of pleural symphysis by sclerosing agents, may be an effective approach with minimal toxicity in patients with malignant pleural effusions.