Marawan H. Elkasas¹, Hamdy D. Elayouty^1,

OBJECTIVE: To compare between mistletoe(Viscum album) and bleomycin as chemical agents for pleurodesis in malignant pleural effusions. METHODS: In this study 50 patients with pathologically confirmed, symptomatic, malignant pleural effusion irrespective of the primary tumor were studied at Suez Canal University hospital in the period of 3 years from January 2009 to December 2012. Patients were divided into 2 groups; 25 patients each: group A(pleurodesis with Mistletoe using 100mg – 5 ampoules-repeated two or three times, injected every other day) and group B(pleurodesis with Bleomycin1 iu/kg average-4 ampoules-or maximally 60 units). follow-up included postero-anterior and lateral chest radiography done after one week, month and 3 months. RESULTS: Most of the patients among both groups show complete remission defined as no effusion detected within four weeks of pleurodesis (72% and 56% among bleomycin and Viscum groups respectively). Significant difference was found between both groups. Recurrences were more frequent among group A (20% versus 8% in group B), P < 0.05. Hospital stay was shorter in the bleomycin group of patients, with a mean of (6.2) day. CONCLUSION: Both bleomycin and Viscum album are effective and safe agents for chemical pleurodesis, however bleomycin has some advantages over Viscum album due to its lower incidence of failure, and being more economic and for the shorter hospital stay.

Viscum album, malignant pleural effusion, mistletoe, bleomycin, pleurodesis