Skip to main content
The Egyptian Journal of Bronchology
Download PDF
  • Original article
  • Open access
  • Published:

Efficacy and safety of intrapleural cisplatin versus silver nitrate in treatment of malignant pleural effusion

Egyptian Journal of Bronchology volume 12, pages 98–104 (2018)Cite this article

Abstract

Introduction

Malignant pleural effusion is a frequent problem. Pleurodesis is performed to prevent its recurrence. New, effective, and safe sclerosing agents are needed.

Aim

The aim of this was to compare efficacy and safety of silver nitrate solution 0.5% versus cisplatin in achievement of pleurodesis in malignant pleural effusion.

Patients and methods

Prospective randomized single-blinded clinical trial performed at Chest, Clinical Oncology and Nuclear Medicine and Pathology Departments, Mansoura University, from February 2016 to March 2017. A total of 60 patients (26 male and 34 female) with malignant pleural effusion were divided into two groups: first group included 30 patients who were managed with silver nitrate pleurodesis, and second group included 30 patients who were managed by intrapleural cisplatin injection. The success rate of pleurodesis was considered if there was no clinical or radiological recurrence of effusion for 1 month after intervention.

Results

There were significant improvements in cough, chest pain, and dyspnea in the two groups after 1 month versus that before pleurodesis. The success rate of pleurodesis in silver nitrate group was 90 versus 76.7% in cisplatin group, without significant difference (P=0.166). Chest pain was reported in 26.7% in silver nitrate group and 13.3% in cisplatin group, and fever was reported in 33.3% in silver nitrate group and 20.0% in cisplatin group. Recurrence was reported in 10% in silver nitrate group and in 23.3% in cisplatin group.

Conclusion

Silver nitrate and cisplatin were nearly equally effective, safe, and less expensive agents in achievement of pleurodesis in patients with malignant effusion with high success rate and low complications.

References

  1. Rafei H, Jabak S, Mina A, Tfayli A. Pleurodesis in malignant pleural effusions: outcome and predictors of success. Integr Cancer Sci Therap 2015; 2:216–221.

    Article  Google Scholar 

  2. Sonoda A, Jeudy J, White CS, Kligerman SJ, Nitta N, Lempel J, Frazier AA. Pleurodesis: indications and radiologic appearance. Jpn J Radiol 2015; 33:241–245.

    Article  Google Scholar 

  3. Janssen JP, Collier G, Astoul P, Tassi GF, Noppen M, Rodriguez-Panadero F, et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet 2007; 369:1535–1539.

    Article  Google Scholar 

  4. Mourad IA, Sherif AM, Aziz A, Saber NM, Fouad FA. Pleurodesis as a palliative treatment of advanced lung cancer with malignant pleural effusion. J Egypt Natl Cancer Inst 2004; 16:188–194.

    Google Scholar 

  5. Light R. Effusion due to malignancy. Textbook of pleural diseases. 6th ed. Wolters Kluwer: Lippincott Williams & Wilkins; 2013. 10:153–189.

  6. Zhao WZ, Wang K, Li W, Zhang XL. Clinical research on recombinant human Ad-p53 injection combined with cisplatin in treatment of malignant pleural effusion induced by lung cancer. Ai Zheng 2009; 28:1324–1327.

    PubMed  Google Scholar 

  7. Belfiore G, Moggio G, Tedeschi E, Greco M, Cioffi R, Cincotti F, et al. CT-guided radiofrequency ablation: a potential complementary therapy for patients with unresectable primary lung cancer – a preliminary report of 33 patients. Am J Roentgenol 2004; 183:1003–1011.

    Article  Google Scholar 

  8. Melzack R. The short-form McGill Pain Questionnaire. Pain 1987; 30:191–197.

    Article  CAS  Google Scholar 

  9. Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest 1988; 93:580–586.

    Article  CAS  Google Scholar 

  10. Mironov O, Ishill NM, Mironov S, Vargas HA, Zheng J, Moskowitz C, et al. Pleural effusion detected at CT prior to primary cytoreduction for stage III or IV ovarian carcinoma: effect on survival. Radiology 2011; 258: 776–784.

    Article  Google Scholar 

  11. Seto T, Ushijima S, Yamamoto H, Ito K, Araki J, Inoue Y, et al. Intrapleural hypotonic cisplatin treatment for malignant pleural effusion in 80 patients with non-small-cell lung cancer: a multi-institutional phase II trial. Br J Cancer 2006; 95:717–721.

    Article  CAS  Google Scholar 

  12. Lee WJ, Kim HJ, Park JH, Park DI, Cho YK, Sohn CI, et al. Chemical pleurodesis for the management of refractory hepatic hydrothorax in patients with decompensated liver cirrhosis. Korean J Hepatol 2011; 17:292–298.

    Article  Google Scholar 

  13. Dresler CM, Olak J, Herndon JE, Richards WG, Scalzetti E, Fleishman SB, et al. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest 2005; 127:909–915.

    Article  Google Scholar 

  14. Davies HE, Lee YCG, Davies RJO. Pleurodesis for malignant pleural effusion: talc, toxicity and where next? Thorax 2008; 63:572–574.

    Article  Google Scholar 

  15. Menna C, Andreetti C, Ibrahim M, Maurizi G, Poggi C, Barile R, et al. The effect of silver nitrate pleurodesis after a failed thoracoscopic talc poudrage. Biomed Res Int 2013; 2013:1–5.

    Article  Google Scholar 

  16. Saffran L, Ost DE, Fein AM, Schiff MJ. Outpatient pleurodesis of malignant pleural effusion using small bore pigtail catheter. Chest 2000; 118: 417–421.

    Article  CAS  Google Scholar 

  17. Parulekar W, Di primio G, Matzinger F, Dennie C, Bociek G. Use of small bore versus large bore chest tube for treatment of malignant pleural effusion. Chest 2001; 120:19–25.

    Article  CAS  Google Scholar 

  18. Caglayan B, Torun L, Turan D, Fidan A, Gemici C, Sarac G, et al. Efficacy of iodopovidone pleurodesis and comparison of small bore catheter versus lage bore chest tube. Ann Surg Oncol 2008; 15:2594–2599.

    Article  Google Scholar 

  19. Dey A, Bhuniya S, Datta Chaudhuri A, Pandit S, Saha-Dutta Chowdhury M, Sengupta A, et al. Iodopovidone pleurodesis: experience of a tertiary hospital in Kolkata. Singapore Med J 2010; 51:163–165.

    CAS  PubMed  Google Scholar 

  20. Paschoalini M, Da S, Vargas FS, Marchi E, Pereira JR, Jatene FB, Antonangelo L. Prospective randomized trial of silver nitrate vs talc slurry in pleurodesis for symptomatic malignant pleural effusions. Chest 2005; 128:684–689.

    Article  Google Scholar 

  21. Terra RM, Kim SY, Pego-Fernandes PM, Teixeira LR, Vargas FS, Jatene FB. Is silver nitrate pleurodesis for patients with malignant pleural effusion feasible and safe when performed in an outpatient setting? Ann Surg Oncol 2011; 18:1145–1150.

    Article  Google Scholar 

  22. Rusch VW, Figlin R, Godwin D, Piantadosi S. Intrapleural cisplatin and cytarabine in the management of malignant pleural effusions: a lung cancer study group trial. J Clin Oncol 1991; 9:313–319.

    Article  CAS  Google Scholar 

  23. Tohda Y, Iwanaga T, Takada M, Yana T, Kawahara M, Negoro S, et al. Intrapleural administration of cisplatin and etoposide to treat malignant pleural effusions in patients with non-small cell lung cancer. Chemotherapy 1999; 45:197–204.

    Article  CAS  Google Scholar 

  24. Figlin R, Mendoza E, Piantadosi S, Rusch V. Intrapleural chemotherapy without pleurodesis for malignant pleural effusions: LCSG Trial 861. Chest 1994; 106(suppl):363s–366s.

  25. Kim KW, Park SY, Kim MS, Kim SC, Lee EH, Shin SY, et al. Intrapleural chemotherapy with cisplatin and cytarabine in the management of malignant pleural effusion. Cancer Res Treat 2004; 36:68–71.

    Article  Google Scholar 

  26. Vargas FS, Antonangelo L, Capelozzi VL, Vaz MA, Genofre EH, Marchi E, Teixeira LR. Lung damage in experimental pleurodesis induced by silver nitrate or talc: 1-year follow-up. Chest 2002; 122:2122–2126.

    Article  Google Scholar 

  27. Mohsen TA, Abou Zeid AA, Meshref M, Haj-Yahi S, et al. Local iodine pleurodesis versus thoracoscopic talc insufflation in recurrent malignant pleural effusion: a prospective randomized control trial. Eur J Cardiothorac Surg 2011; 40:282–286.

    PubMed  Google Scholar 

  28. El-Morsy AS, El-Desoky ME, Fouda MA, Mansour AE, E l-Hadidy TA. Comparative study of povidone iodine and viscum as pleurodesis agents via large bore chest tube aftermedical thoracoscopy and small bore catheter in malignant pleural effusion. Egypt J Chest Dis Tuberc 2012; 61:112–119.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Chest Medicine, Mansoura University, 15-Beshbeshi St, Hay Elgamaa, Mansoura, Egypt

    Mohammad K. El Badrawy, Raed El-Metwally Ali, Asem A. Hewidy MD & Mohamed A. El-Layeh

  2. Clinical Oncology & Nuclear Medicine, Mansoura University, Mansoura, Egypt

    Fatma M. F. Akl

  3. Pathology, Mansoura University, Mansoura, Egypt

    Abdelhadi Shebl

Authors
  1. Mohammad K. El Badrawy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raed El-Metwally Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Asem A. Hewidy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed A. El-Layeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fatma M. F. Akl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abdelhadi Shebl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Asem A. Hewidy MD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El Badrawy, M.K., Ali, R.EM., Hewidy, A.A. et al. Efficacy and safety of intrapleural cisplatin versus silver nitrate in treatment of malignant pleural effusion. Egypt J Bronchol 12, 98–104 (2018). https://doi.org/10.4103/ejb.ejb_39_17

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_39_17

Key words