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Safety and Effectiveness of Three Different Doses of Silver Nitrate for Pleurodesis in Patients With Malignant Pleural Effusion: Preliminary Results FREE TO VIEW

Ricardo M. Terra, MD; Renato T. Bellato; Lucas O. Hortencio; Lisete R. Teixeira, MD; Rodrigo C. Chate, MD; Larissa K. Camelo, MD; Mateus G. Fahel, MD; Fabio B. Jatene, MD
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University of Sao Paulo Medical School, Sao Paulo, Brazil

Chest. 2010;138(4_MeetingAbstracts):811A. doi:10.1378/chest.10355
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PURPOSE: The objective of this study was to evaluate the safety of pleurodesis with silver nitrate for malignant pleural effusions using three different dosages.

METHODS: Double-blind, randomized, prospective study including patients with malignant pleural effusion eligible for pleurodesis. Patients underwent chest catheter insertion followed by infusion of silver nitrate in three different concentrations and volumes: (Group 1)0.3%, (Group 2)30ml ; (Group 3)0.5%, 30ml ;0.3%, 60ml . Hepatobiliary, renal, hematologic and inflammatory parameters were monitored through blood exams in the first 72 hours, on the 7th and on the 30th day.Pain, dyspnea and oxymetry were likewise measured. On the 30th day quality of life and effusion recurrence were evaluated according to a genereal questionnary and chest CT scan, respectively.

RESULTS: During six months, 36 patients were selected, 3 being excluded due to trapped lung after drainage and 6 had not completed the 30-day follow-up at the end of data collection. Therefore, 27 patients (21 female, 6 male) were studied so far, mean age 60.14ys (±14.72). After pleurodesis, an expressive increase in CRP levels and leukocyte count was noted in all groups. The leukocyte increase appeared to be more notable on patients who received larger loads of silver nitrate, although that difference was not statistically significant. Neither have we found significant difference among groups regarding pain after pleurodesis . Adverse effects (graded by the CTCAEV 4.0 as 3 or higher) were noted in all groups as follows: hepatobiliary enzimes elevation (9 patients), serum creatinin elevation (1) and supraventricular tachycardia (1). No fatalities were observed. Recurrence of the effusion after pleurodesis was observed in only one patient.

CONCLUSION: Silver nitrate pleurodesis was very effective in all doses. Adverse events were higher than previously noted, particularly hepatobiliary toxicity. Apparently larger doses cause more toxicity, but with the present sample size results were not significant (this is an ongoing trial).

CLINICAL IMPLICATIONS: This study provides more information regarding safety of the silver nitrate pleurodesis.

DISCLOSURE: Ricardo Terra, No Financial Disclosure Information; No Product/Research Disclosure Information

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