MITOXANTRONE PLEURODESIS - WHEN TALC IS NOT AN OPTION!

Introduction: About 40% of pleural effusions are caused by malignant disease. Chemical pleurodesis with a sclerosing agent is the usual treatment. Talc, despite its´side effects, is the most common sclerosing. At our institution is not possible to use talc, so we an alternative agent, mitoxantrone. Aims and Objectives: The aim of this retrospective study is to describe the use of mitoxantrone as a sclerosing agent in a group of patients. Methods: Patients undergoing pleurodesis with mitoxantrone, between 2007 and 2016, were enrolled. A chest tube was inserted and when drainage was below 200 ml / 24 h mitoxantrone was instilled, the dosage being calculated according to body surface area. The tube was unclamped after 6h. Follow up with chest x-ray was done. The success of pleurodesis was defined by the relapse, or not, of the effusion. Results: Data of 57 patients with neoplastic pleural effusion was collected: lung 23, breast 9, gastrointestinal 9, lymphoma 4, mesothelioma 2, ovary 1, urologic 3, others 6. The overall success rate was 44%. Regarding complications, there were 3 pneumothoraxs, 1 infection of the insertion site and 1 subcutaneous emphysema. A second pleurodesis was attempted in 21 patients and the success rate was 71%. Conclusions: Our results demonstrate that mitoxantrone is a safe agent, without major side effects or complications, however its effectiveness is lower than talc. The success rate of mitoxantrone in this study is lower than that found in similar studies. This may be due to the fact that the drain clamp time is only 6 hours, vs 48 hours in other studies. A second instillation seems to be effective with a recurrence rate of 29%. The safety profile of mitoxantrone in alternative to talc is therefore highlighted.