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Para el tratamiento del derrame pleural maligno se dispone de varias modalidades terapéuticas. 1) Técnicas evacuadoras: los diuréticos, las toracocentesis y el drenaje con tubo eliminan el derrame, pero la recidiva suele ser la regla. Las derivaciones pleuro-venosas y pleuro-peritoneales, así como los reservorios para toracocentesis repetidas, están en fase de experimentación clínica y su uso se restringe a pacientes en mal estado general que no soportarían tratamientos más agresivos. 2) La radioterapia está indicada ante la presencia de adenopatías mediastínicas, linfoma o atelectasia pulmonar por obstrucción tumoral endobronquial. 3) La pleurectomía se reserva para pacientes con buen estado general, sin otras metástasis, cuando ha fracasado el tratamiento intrapleural. 4) Terapia intracavitaria: los productos sinfisantes, sobre todo el talco y el clorhidrato de tetraciclina, son los más indicados por producir pleurodesis duradera. Es la modalidad terapéutica más empleada por su elevada eficacia y baja morbilidad.
Many therapeutic modalities exist to manage the malignant pleural effusion. 1. Evacuative techniques: Diuretics, thoracocentesis and drainage with tube remove the effusion but recurrency is the rule. The pleuro-venous and pleuro-peritoneal bypass as well as the reservoir for repeated thoracocentesis are in clinical experimental stage and their use is restricted to patients in bad conditions who probably did not undergo a more aggressive treatment. 2. When mediastinal adenopathies, lymphoma or pulmonary atelectasia are present, radiotherapic treatment is indicated. 3. The pleurectomy is reserved for the patients in good condition with no other metastases, when the intrapleural treatment has failed. 4. Intracavitary therapy: the symphisant products, such as talc and tetracycline hydrochoride, are the most indicated to produce a durable pleurodesis. This is the most employed therapeutic modality owing to its high efficacy and low morbidity.
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Bibliografia
[1.]
B. Chernow, S.A. Sahn.
Carcinomatous involvement of the pleura: an analysis of 96 patients.
Am J Med, 63 (1977), pp. 695-702
[2.]
E.C. Leuallen, D.T. Carr.
Pleural effusion: a statistical study of 436 patients.
N Engl J Med, 252 (1955), pp. 79-83
[3.]
A. Hirsch, P. Ruffie, M. Nebut, J. Bignon, J. Chrétien.
Pleural effusion. Laboratory test in 300 cases.
Thorax, 34 (1979), pp. 106-112
[4.]
R.N. Raju, C.G. Kardinal.
Pleural effusion in breast carcinoma: analysis of 122 cases.
Cancer, 48 (1981), pp. 2.524-2.527
[5.]
J.B. Weeth, A. Segaloff.
Diuretic therapy for malignant effusion.
JAMA, 181 (1962), pp. 258-260
[6.]
C.J. Lambert, H.H. Shah, H.C. Urschel Jr., D.L. Paulson.
The treatment of malignant pleural effusions by closed trocar tube drainage.
Ann Thorac Surg, 3 (1967), pp. 1-5
[7.]
J. Mejer, K.M. Mortensen, H.H. Hansen.
Mepacrine hydrochloride in the treatment of malignant pleural effusion.
Scan J Resp Dis, 58 (1977), pp. 319-323
[8.]
W. O’Neil, C. Spurr, H. Muss, F. Richards, D. White, C. Cooper.
A prospective study of chest tube drainage and tetracycline (TCN) selerosis versus chest tube drainage alone in the treatment of malignant pleural effusion.
Proc Am Ass Cancer Res and ASCO Abstract C-120, (1980), pp. 349
[9.]
A.V. Pollock.
The treatment of resistent malignant ascites by insertion of a peritoneoatrial Holter valve.
Br J Surg, 62 (1975), pp. 104-107
[10.]
J. Oosterlee.
Peritoneovenous shunting for ascites in cancer patients.
Br J Surg, 67 (1980), pp. 663-666
[11.]
J.L. Weese, J.T. Schouten.
Pleural peritoneal shunts for the treatment of malignant pleural effusions.
Surg Gynec Obstet, 154 (1982), pp. 391-392
[12.]
J.L. Weese, J.T. Schouten.
Internal drainage of ¡ntractable malignant pleural effusions.
Wisconsin Med J, 83 (1984), pp. 21-23
[13.]
J.W. Milsom, I.L. Kron, K.S. Rheuban, B.M. Rodgers.
Chylothorax: an assessment of current surgical management.
J Thorac Cardiovasc Surg, 89 (1985), pp. 221-227
[14.]
H.I. Pass, J.A. Roth.
Treatment of chylothorax.
J Thorac Cardiovasc Surg, 90 (1985), pp. 451
[17.]
Janni A, Dini P, Macchiarini P, Menconi GF, Ricagna F. A new device permanently implanted in pleural effusion relapse. In: Stam J, Siebelink J, Vanderschueren R, Wagenaar J (Eds.). The lung and the environment. 6th Congress of the European Society of Pneumology (SEP). Amsterdam, 1987; Abstract 488; 194.
[18.]
S.J. Strober, E. Klotz, A. Kuperman, N.A. Ghossein.
Malignant pleural disease. A radiotherapeutic approach to the problem.
JAMA, 226 (1973), pp. 296-299
[19.]
R. Brueneau, P. Rubin.
The management of pleural effusions and chylothorax in lymphoma.
Radiology, 85 (1965), pp. 1.085-1.092
[20.]
J.K. Weick, J.M. Kiely, E.G. Harrison Jr., D.T. Carr, P.W. Scanlon.
Pleural effusion in lymphoma.
Cancer, 31 (1973), pp. 848-853
[21.]
P.A. Thomas, P.W. Gebauer.
Pleurectomy for recurrent spontaneous pneumothorax.
J Thorac Surg, 35 (1958), pp. 111-117
[22.]
C.V. Ruckley, R.J.M. McCormack.
The management of spontaneous pneumothorax.
Thorax, 21 (1966), pp. 139-144
[23.]
A.R. Askew.
Parietal pleurectomy for recurrent pneumothorax.
Br J Surg, 63 (1976), pp. 203-205
[24.]
S.V. Singh.
The surgical treatment of spontaneous pneumothorax by parietal pleurectomy.
Scan J Thor Cardiovasc Surg, 16 (1982), pp. 75-80
[25.]
T.B. Ferguson, T.H. Burford.
The role of surgery in the management of unilateral pleural effusion.
Ann Int Med, 50 (1959), pp. 981-998
[26.]
R. Jensik, J.E. Cagle Jr., F. Milloy, C. Perlia, S. Taylor, S. Kofman, E.J. Beattie Jr..
Pleurectomy in the treatment of pleural effusion due to metastatic malignancy.
J Thorac Cardiovasc Surg, 46 (1963), pp. 322-330
[27.]
N. Martini, M.S. Bains, E.J. Beattie Jr..
Indications for pleurectomy in malignant effusion.
Cancer, 35 (1975), pp. 734-738
[28.]
J.J. Rivas de Andrés, A. Cantó, J. Moya.
Pleurodesis: indicaciones, ténicas y resultados.
Arch Bronconeumol, 20 (1984), pp. 256-263
[31.]
H.E. Webb, S.W. Oaten, C.P. Pike.
Treatment of malignant ascitic and pleural effusions with Corynebacterium parvum.
Brit Med J, 1 (1978), pp. 338-340
[32.]
J.W. Millar, A.M. Hunter, N.W. Horne.
Intrapleural immunotherapy with Corynebacterium parvum in recurrent malignant pleural effusions.
Thorax, 35 (1979), pp. 856-859
[33.]
J.S. Chambers.
Palliative treatment of neoplastic pleural effusion with intercostal intubation and talc instillation.
Western J Surg Obst Gynec, 66 (1958), pp. 26-28
[34.]
J. Scarbonchi, C. Boutin, P. Cargnino, T. Scarbonchi-Efimieff.
Le talcage pleural dans les pleurésies cancéreuses.
Poumon-Coeur, 37 (1981), pp. 283-289
[35.]
J. Migueres, A. Jover.
Indications du talcage de plévre sous pleuroscopie au cours des pleurésies malignes récidivantes.
PoumonCoeur, 37 (1981), pp. 295-297
[36.]
I.S. Fentiman, R.D. Rubens, J.L. Hayward.
Control of pleural effusions in patients with breast cancer. A randomized trial.
Cancer, 52 (1983), pp. 737-739
[37.]
R.H. Adler, I. Sayek.
Treatment of malignant pleural effusion: a method using tube thoracostomy and talc.
Ann Thorac Surg, 22 (1976), pp. 8-15
[38.]
R.C. Camishion, J.H. Gibbon Jr., T.F. Nealon Jr..
Talc poudrage in the treatment of pleural effusion due to cancer.
Surg Clin North Am, 42 (1962), pp. 1.521-1.526
[39.]
A.R. Shedbalkar, J.M. Head, L.R. Head, D.J. Murphy, J.H. Mason.
Evaluation of talc pleural symphysis in management of malignant pleural effusion.
J Thorac Cardiovasc Surg, 61 (1971), pp. 492-497
[40.]
R.H. Adler, B.W. Rappole.
Recurrent malignant pleural effusions and talc powder aerosol treatment.
Surgery, 62 (1967), pp. 1.000-1.006
[41.]
D. Weissberg.
Talc pleurodesis. A controversial issue.
Poumon-Coeur, 37 (1981), pp. 291-294
[42.]
A. Frankel, I. Krasna, I.D. Baronofsky.
An experimental study of pleural symphysis.
J Thorac Cardiovasc Surg, 42 (1961), pp. 43-51
[43.]
J.E. Rinaldo, G.R. Owens, R.M. Rogers.
Adult respiratory distress syndrome following intrapleural instillation of talc.
J Thorac Cardiovasc Surg, 85 (1983), pp. 523-526
[44.]
A. Bouchama, J. Chastre, A. Gaudichet, P. Soler, C. Gibert.
Acute pneumonitis with bilateral pleural effusion after talc pleurodesis.
Chest, 86 (1984), pp. 795-797
[45.]
R.M. Rubinson, H. Bolooki.
Intrapleural tetracycline for control of malignant pleural effusion.
South Med J, 65 (1972), pp. 847-849
[46.]
G.K. Thorsrud.
Pleural reactions to irritants.
Acta Chir Scand, 355 (1965), pp. 1-74
[47.]
S.A. Sahn, J.T. Good Jr., D.E. Pott.
The pH of sclerosing agents. A determinant of pleural symphysis.
Chest, 76 (1979), pp. 198-200
[48.]
H.W. Wallach.
Intrapleural tetraeyeline for malignant pleural effusions.
Chest, 68 (1975), pp. 510-512
[50.]
T.C. Bayly, D.L. Kisner, A. Sybert, J.S. MacDonald, E. Tsou, P.S. Schein.
Tetraeyeline and quinacrine in the control of malignant pleural effusion.
Cancer, 41 (1978), pp. 1.188-1.192
[51.]
A.J. Zaloznik, S.G. Oswald, M. Langin.
Intrapleural tetracycline in malignant pleural effusions. A randomized study.
Cancer, 51 (1983), pp. 752-755
[52.]
A.F. Olivier.
Tetracycline pleurodesis for refractory. pneumothorax among inoperable elderly surgical candidates.
Chest, 82 (1982), pp. 512
[53.]
J.E. Ultman, A. Gellhorn, M. Osnos, E. Hirschberg.
The effect of quinacrine on neoplastic effusions and certain of their enzymes.
Cancer, 16 (1963), pp. 283-288
[54.]
M.R. Dollinger, I.H. Krakoff, D.A. Karnofsky.
Quinacrine (atabrine) in the treatment of neoplastic effusions.
Ann Inter Med, 66 (1967), pp. 249-257
[55.]
J.A. Hickman, M.C. Jones.
Treatment of neoplastic pleural effusions with local instillations of quinacrine (mepacrine) hydrochloride.
Thorax, 25 (1970), pp. 226-229
[56.]
G. Stiksa, R. Korsgaard, B.G. Simonsson.
Treatment of recurrent pleural effusion by pleurodesis with quinacrine Comparison between instillation by repeated thoracocenteses and by tube drainage.
Scand J Respir Dis, 60 (1979), pp. 197-205
[57.]
American Medical Association Council on Drugs.
An agent for the palliative treatment of neoplastic effusions: quinacrine hydrochloride.
JAMA, 195 (1966), pp. 1.139
[58.]
D.B. Rochlin, C.R. Smart, D.E. Wagner, A.R.N. Silva.
The control of recurrent malignant effusions using quinacriné hydrochloride.
Surg Gynec Obstet, 118 (1964), pp. 991-994
[59.]
S.A. Taylor, N.S. Hooton, A.M. MacArthur.
Quinacrine in the management of malignant pleural effusions.
Br J Surg, 64 (1977), pp. 52-53
[60.]
I. Borda, M. Krant.
Convulsions following intrapleural administration of quinacrine hydrochloride.
JAMA, 201 (1967), pp. 1.049-1.050
[61.]
W.B. Seaman, A.I. Sherman, M. Bonebrake.
Radioactive gold in the treatment of malignant effusions.
JAMA, 153 (1953), pp. 630-633
[62.]
E.M. Kent, C. Moses, W.B. Ford, E.R. Kutz, R.S. George.
Radioactive isotopes in management of carcinomatosis of serous body cavities.
Arch Int Med, 94 (1954), pp. 334-340
[63.]
N. Mackay.
Radioactive colloidal gold in the treatment of pleural and peritoneal effusions of malignant origin (review of 235 cases).
Lancet, 2 (1957), pp. 761-764
[64.]
R.G. Rose.
Intracavitary radioactive colloidal gold. Results in 257 cancer patients.
J Nucl Med, 3 (1962), pp. 323-331
[65.]
T.W. Botsford.
Experiences with radioactive colloidal gold in the treatment of pleural effusion caused by metastatic cancer of the breast.
N Engl J Med, 270 (1964), pp. 552-555
[66.]
H.L. Jaffe.
Treatment of malignant serous effusions with radioactive colloidal chromic phosphate.
Am J Roentgen, 74 (1955), pp. 657-666
[67.]
R.H. Lange, J.L. Shields, H.M. Rozendaal.
Colloidal radioactive chromic phosphate in the control of malignant effusions.
N Y S J Med, 56 (1956), pp. 1.928-1.931
[68.]
M.L. Jacobs.
Radioactive colloidal chromic phosphate to control pleural effusion and ascites.
JAMA, 166 (1958), pp. 597-599
[69.]
D. Nori, C.R. Moorthy, B.S. Hilaris, M.A. Batata, F. Chu, N. Martini.
Intrapleural instillation of radioactive chromic phosphate in malignant pleural effusion.
Indian J Cancer, 18 (1981), pp. 288-291
[70.]
E.P. Siegel, H.E. Hart, M. Brothers, H. Spencer, D. Laszlo.
Radioyttrium (Y 90) for the palliative treatment of effusions due to malignaney.
JAMA, 161 (1956), pp. 499-503
[71.]
R.G. Rose, M.P. Osborne, W.B. Stevens.
The intracavitary administration of radioactive colloidal gold.
N Engl J Med, 247 (1952), pp. 663-667
[72.]
R.M. Kniseley, G.A. Andrews.
Pathological changes following intracavitary therapy with colloidal Au 198.
Cancer, 6 (1953), pp. 303-312
[73.]
J. Walter.
Radioactive gold in malignant effusions.
Proc R Soc Med, 46 (1953), pp. 466-471
[74.]
J.C. Bateman, B. Moulton, N.J. Larsen.
Control of neoplastic effusion by phosphoramide chemotherapy.
Arch Int Med, 95 (1955), pp. 713-719
[75.]
H.P. Groesbeck, J.T.P. Cudmore.
Intracavitary thio-tepa for malignant effusions.
Amer Surg, 28 (1962), pp. 90-95
[76.]
A.P. Andersen, H. Brincker.
Intracavitary thio-tepa in malignant pleural and peritoneal effusions.
Acta Radiol, 7 (1968), pp. 369-378
[77.]
A.B. Macgregor, D.A.A. Macleod, J.W.W. Thomson.
Combined chemotherapy in the treatment of malignant effusions.
Br J Surg, 56 (1969), pp. 489-491
[78.]
L.G. Suhrland, A.S. Weisberger.
Intracavitary 5-fluorouracil in malignant effusions.
Arch Intern Med, 116 (1965), pp. 431-433
[79.]
A.S. Weisberger, B. Levine, J.P. Storaasli.
Use of nitrogen mustard in treatment of serous effusions of neoplastic origin.
JAMA, 159 (1955), pp. 1.704-1.707
[80.]
L. Taylor.
A catheter technique for intrapleural administration of alkilating agents: a report of ten cases.
Am J Med Sci, 244 (1962), pp. 706-716
[81.]
A.S. Weisberger.
Direct instillation of nitrogen mustard in the management of malignant effusions.
Ann N Y Acad Sci, 68 (1958), pp. 1.091-1.096
[82.]
V.B. Levison.
Nitrogen mustard in palliation of malignant effusions.
Br Med J, 5233 (1961), pp. 1.143-1.145
[83.]
J.B.D. Mark, I.S. Goldenberg, A.C.W. Montague.
Intrapleural mechlorethamine hydrochloride therapy for malignant pleural effusion.
JAMA, 187 (1964), pp. 858-860
[84.]
B.J. Leininger, W.L. Barker, H.T. Langston.
A simplified method for management of malignant pleural effusion.
J Thorac Cardiovasc Surg, 58 (1969), pp. 758-763
[85.]
S.D. Desai, A. Figueredo.
Intracavitary doxorubicin in malignant effusions.
Lancet, 1 (1979), pp. 872
[86.]
M.H.N. Tatterstal, R.M. Fox, E.S. Newlands, R.L. Woods.
Intracavitary doxorubicin in malignant effusions.
Lancet, 1 (1979), pp. 390
[87.]
T.J. Cunningham, K.B. Olson, J. Horton, A. Wright, M. Hussain, J.N.P. Davies, G. Harrington.
A clinical trial of intravenous and intracavitary bleomycin.
Cancer, 29 (1972), pp. 1.413-1.419
[88.]
W. Paladine, T.J. Cunningham, R. Sponzo, M. Donavan, K. Olsson, J. Horton.
Intracavitary bleomycin in the management of malignant effusions.
Cancer, 38 (1976), pp. 1.903-1.908
[89.]
M.J. Ostrowski, G.M. Halsall.
Intracavitary bleomycin in the management of malignant effusions: a multicenter study.
Cancer Treat Rep, 66 (1982), pp. 1.903-1.907
[90.]
A.J. Lippman, F.B. Cohen, M.C. Custodio.
A clinical trial of intracavitary bleomycin.
Proc Am Assoc Cancer Res and ASCO, 16 (1975), pp. 1.104
[91.]
N. Gupta, R.W. Opfell, J. Padova, D. Margileth, J. Souadjian.
Intrapleural bleomycin versus tetracycline for control of malignant pleural effusions: a randomized study.
Proc Am Assoc Cancer Res and ASCO, 21 (1980), pp. 189
[92.]
J.D. Bitran, C. Brown, R.K. Desser, M.F. Kozloff, C. Shapiro, A.A. Billings.
Intracavitary bleomycin for the control of malignant effusions.
J Surg Oncol, 16 (1981), pp. 273-277
[93.]
M.R. Law, M.E. Hodson, M. Turner-Warwick.
Malignant mesothelioma of the pleura: clinical aspects and symptomatic treatment.
Eur J Respir Dis, 65 (1984), pp. 162-168
[94.]
D. Alberts, H.S. Chen, R. Liu, J. Chen, M. Mayersohn, D. Perrier, T. Moon, J. Gross, A. Broughton, S. Salmon.
Systemic absorption of bleomycin after intracavitary administration.
Proc Am Assoc Cancer Res and ASCO, 19 (1978), pp. 305
[95.]
D.S. Alberts, H.S.G. Chen, M. Mayersohn, D. Perrier, T.E. Moon, J.F. Gross.
Bleomycin pharmacokinetics in man II: intracavitary administration.
Cancer Chemother Pharmacol, 2 (1979), pp. 127-132
[96.]
J.M. Trotter, J.F.B. Stuart, F. McBeth, J.G. McVie, K.C. Calman.
The management of malignant effusions with bleomycin.
Brit J Cancer, 40 (1978), pp. 310
[97.]
Rami Porta R, Bravo Bravo JL, Pastor Durán X, Mañés Bonet N, Alix Trueba A, Serrano Muñoz F. Survival after intracavitary therapy for malignant pleural effusion. En: Stam J, Siebelink J, Vanderschueren R, Wagenaar J (Eds). The lung and the environment. 6th Congress of the European Society of Pneumology (SEP). Amsterdam, 1987; Abstract 40; 16.
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