Yonsei Med J.  2007 Dec;48(6):1035-1038. 10.3349/ymj.2007.48.6.1035.

A Case of Successful Intrapleural Chemotherapy with Cisplatin Plus Cytarabine for Intractable Malignant Pleural Effusion

• Moon YW
• Choi ST
• Cho BC
• Choi HJ
• Kim YT

• KMID: 1786221
• DOI: http://doi.org/10.3349/ymj.2007.48.6.1035

Abstract

When conventional treatments of malignant pleural effusion, such as repeated thoracentesis, closed thoracotomy and pleurodesis by instilled sclerosing agents, are ineffective, there are few alternative therapies available. Our case involves a 47-year-old woman with uterine cervical carcinoma suffering from malignant pleural effusion. She presented with a chief complaint of severe dyspnea, and was classified as an Eastern Cooperative Oncology Group (ECOG) performance status of 4. Her underlying cervical carcinoma progressed despite various systemic chemotherapy regimens. In addition, pleural effusion persisted in spite of 4 weeks of drainage through the thoracotomy tube and talc pleurodesis. Under such circumstances, we attempted intrapleural chemotherapy with cisplatin plus cytarabine, which resulted in significant decrease of the pleural effusion. No serious systemic toxicities, including myelosuppression, were observed. As a result, the patient's dyspnea was relieved, and her ECOG performance status improved from 4 to 2. However, the thoracotomy tube was not removed due to subsequent iatrogenic pneumothorax. Pleural effusion did not recur for the 4 weeks leading up to her death.

Keyword

Intractable pleural effusion; intrapleural chemotherapy; cisplatin; cytarabine

MeSH Terms

Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
Cisplatin/administration & dosage
Cytarabine/administration & dosage
Fatal Outcome
Female
Humans
Middle Aged
Pleural Effusion, Malignant/*drug therapy
Treatment Outcome

Figure

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  Fig. 1 Chest CT scan performed on admission. Large amount of pleural effusion in the left lung and multiple lung metastases were observed.

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  Fig. 2 At the time of admission. Huge amount of pleural effusion in the left lung and the deviation of the heart and the trachea were noted.

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  Fig. 3 After pleurodesis. A small decrease of pleural effusion in the left lung was seen. On hospital day 26, even pleurodesis with 2.0 g talc was not significantly effective.

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  Fig. 4 After intrapleural chemotherapy. Pleural effusion in the left lung greatly decreased and left lung reexpanded fully. On day 11 of intrapleural chemotherapy with cisplatin plus cytarabine, the median amount of drained fluid decreased to 110 mL.

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