Pleural effusions caused by malignancy occur commonly and are generally a manifestation of the advanced disease. Regardless of the underlying tumor type, mortality within 30 days has been reported to be as high as 50%. Respiratory insufficiency
due
to
malignant pleural effusion often demands palliative management of the effusion. Malignant pericardial effusion is one of the most common causes of cardiac tamponade. Bleomycin and tetracycline have been widely used as sclerosing agents in
malignant
pleural effusion in North America and Europe Bleomycin is less often used in the mallgnant pericardial effusion but is efficacious. Our study was begun to assess the effect and safety of bleomycin pleurodesis/pericardiodesis. Prospectively
assigned
twenty patients with malignant effusion(pleural effusion: 15, pericardial effusion: 5) to this therapy. Their age ranged from 19 to 69 years with a median of 47 years. Primary sites were lung in 10, colon in 2, stomach, breast, uterine cervix,
leg(sarcoma), mediastinum(malignant lymphoma), kidney in 1 each and unknown in 2(malignant melanoma and adenocarcinoma). The responses were categorized as objective response or failure. Twelve patients(70.5%) showed an objective response(complete
response: 47% (8 cases), partial response: 23.5% (4 cases) out of 17 evaluable cases and the duration ranged from 5 to 78 weeks with a median of 16 weeks. The response rates of malignant pericardial effusion and pleural effusion were 100% and
61.5%
respectively. Chest pain(10/17), and fever and/or chill(9/17) were the most common side effects. Other untoward effects included vomiting(4/17), anorexia(3/17), hypersensitivity(1/17), pyothorax(1/17). We conclude that bleomycin pleurodesis and
pericardiodesis in malignant effusion can be performed safely and show good treatment effects, especially in malignant pericardial effusion.
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