Viscum Album Therapy in Malignant Pleural Effusion

악성 흉막삼출액에서 Viscum Album 치료

  • 김종중 (조선대학교 의과대학 흉부외과학교실) ;
  • 이석기 (조선대학교 의과대학 흉부외과학교실) ;
  • 임진수 (조선대학교 의과대학 흉부외과학교실) ;
  • 최형호 (조선대학교 의과대학 흉부외과학교실)
  • Published : 2004.12.01


Background: Malignant pleural effusion is a common clinical problem in neoplastic patients. With the diagnosis of a malignant pleural effusion, palliative therapy was done. One of the treatments was a chemical pleurodesis. Talc was the most commonly used a sclerosing agent, but the quality of patient's life was not improved. We was evaluated by other agents such as Viscum album for relief of malignant pleural effusion. Material and Method: From November 2001 to October 2003, 17 patients who underwent to chemical pleurodesis for the malignant pleural effusion. We compared the talc (group I: 10 patients) and Viscum album (group II: 7 patients). We analysed them retrospectively in term of various factors and results. Result: There were no significant differences between group I and group II in the sex ratio, mean age, origin of primary cancer and site, but, group I had higher successful rate (80% : 71 %) than group II. Group II had better length of chest tube stay after procedure, Karnofsky performance and recurrence than group I. The failed treatement group was related to the pleural fluid pH and interval of initial chemical pleurodesis after thoracostomy. Conculsion: Although the chemical pleurodesis with Viscum album was slightly lower than talc in the successful rate, there was an alternative method instead of the chemical pleurodesis with talc to improve the patient's quality of life in malignant pleural effusion.


  1. American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med 2000;162:1987-2001.
  2. Meyer PC. Metastatic carcinoma of the pleura. Thorax 1966; 21:437-43.
  3. Lee YC, Baumann MH, Maskell NA, et al. Pleurodesis practice for malignant pleural effusions in five English- speaking countries: survey of pulmonologists. Chest 2003;124:2229-38.
  4. Marel M, Zrustova M, Stasny B, Light RW. The incidence of pleural effusion in a well-defined region. Epidemiologic study in central Bohemia. Chest 1993;104:1486-9.
  5. Rodriguez-Panadero F, Rorderas Naranjo F, Lopez-Mejias J. Pleural metastatic tumours and effusions: frequency and pathogenic mechanism in a post-mortem series. Eur Respir J 1989;2:366-9.
  6. orcel JM, Vives M. Etiology and pleural fluid characteristics of large and massive effusions. Chest 2003;124:978-83.
  7. Rehse DH, Aye RW, Florence MG. Respiratory failure following talc pleurodesis. Am J Surg 1999;177:437-40.
  8. Yoon TJ, Yoo YC, Kang TB, et al. Antitumor activity of the Korean mistletoe lectin is attributed to activation of macrophages and NK cells. Arch Pharm Res 2003;26:861-7
  9. Zhu HG, Zollner TM, Klein-Franke A, Anderer FA. Enhancement of MHC-unrestricted cytotoxic activity of human CD56⁢ CD3⁣ natural killer (NK) cells and CD3⁢ T cells by rhamnogalacturonan: target cell specificity and activity against NK-insensitive targets. J Cancer Res Clin Oncol 1994;120:383-8.
  10. Hauer J, Anderer FA. Mechanism of stimulation of human natural killer cytotoxicity by arabinogalactan from Larix occidentalis. Cancer Immunol Immunother 1993;36:237-44.
  11. Stein GM, Pfuller U, Schietzel M, Bussing A. Toxic proteins from European mistletoe (Viscum album L.): increase of intracellular IL-4 but decrease of IFN-gamma in apoptotic cells. Anticancer Res 2000;20:1673-8.
  12. Van Huyen JP, Bayry J, Delignat S, et al. Induction of apoptosis of endothelial cells by Viscum album: a role for anti-tumoral properties of mistletoe lectins. Mol Med 2002; 8:600-6.
  13. Timoshenko AV, Lan Y, Gabius HJ, Lala PK. Immunotherapy of C3H/HeJ mammary adenocarcinoma with interleukin-2, mistletoe lectin or their combination. effects on tumour growth, capillary leakage and nitric oxide (NO) production. Eur J Cancer 2001;37:1910-20.
  14. Salzer G. Pleura carcinosis. Cytomorphological findings with the mistletoe preparation Iscador and other pharmaceuticals. Oncology 1986;43(Suppl 1):66-70.
  15. Salzer G, Muller H. Topical treatment of malignant pleural effusions with iscador, a mistletoe preparation. Prax Klin Pneumol 1978;32:721-9.
  16. Stumpf C, Bussing A. Stimulation of antitumour immunity by intrapleural instillation of a Viscum album L. extract. Anticancer Drugs 1997;8(Suppl 1):S23-6.
  17. Kennedy L, Sahn SA. Talc pleurodesis for the treatment of pneumothorax and pleural effusion. Chest 1994;106:1215-22.