Influence of intrapleural treatment with doxorubicin on survival in patients with malignant pleural effusion

This study investigates clinical characteristics and survival in patients with malignant pleural effusion (MPE).When conventional treatments of MPE, such as repeated thoracentesis, systemic chemotherapy, pleurodesis by instilled sclerosing agents, are ineffective, intrapleural chemotherapy is available. During a five-year period, consecutive pleural effusions were collected prospectively. Patient clinical characteristics and overall survival (OS) were analysed. In particular, we considered the survival of patients with MPE who underwent palliative treatment with intrapleural administration of doxorubicin (DOX), using pleural catheter placement methods. We collected MPEs from 262 patients with various primary and secondary tumors. The main causes of MPE were lung carcinoma, breast cancer, ovarian cancer and pleural mesothelioma. There were 162 (61.8%) males and 100 (38.2%) females, with an overall median age of 62 years (range 32-81 years). Seventy-two patients (27.5%) were treated with intrathoracic administration of DOX at a dose of 20-30 mg. No serious systemic toxicities, including hematologic, cardiopulmonary and renal toxic reactions, were observed. Median OS in all patients with MPEs was 8.3 months. Median OS in patients treated and not treated with local administration of DOX was 11.1 months and 7.2 months, respectively (p=0.013). Our results show a better prognosis in patients after intrapleural chemotherapy with DOX.