Chest
Volume 128, Issue 3, September 2005, Pages 1431-1435
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Clinical Investigations
Clinical Efficacy and Safety of Thoracoscopic Talc Pleurodesis in Malignant Pleural Effusions

https://doi.org/10.1378/chest.128.3.1431Get rights and content

Study objectives

In patients with disseminated neoplastic disease, recurrent pleural effusion is frequently observed. The purpose of this study was to determine the long-term efficacy and safety of pleurodesis by thoracoscopic talc poudrage (TTP) in malignant pleural effusions (MPEs).

Methods

We report a consecutive series of 102 patients (45 women, 57 men; 20 to 83 years of age) who underwent medical thoracoscopy and TTP for recurrent MPE between 1999 and 2001. Thoracoscopy was performed utilizing local anesthesia and IV sedation (medical thoracoscopy). For pleurodesis, an average of 8 g of sterile talc powder was used. One hundred eighty-day follow-up was completed for all patients, and outcome measures included time to recurrence of the effusion and survival. Efficacy was judged by clinical examination, chest radiograph, and/or thoracic ultrasound examination. Procedure-related complications were documented.

Results

The most common primary neoplasms were lung cancer (n = 48), breast cancer (n = 16), and malignant pleural mesothelioma (n = 10). Twenty-eight patients had other types of tumors, including renal cell carcinoma, ovarian carcinoma, GI tumors, prostate, malignant lymphoma, and unknown primary cancer. At the end of the primary observation period of 180 days, 38 of 46 surviving patients (82.6%) had a successful pleurodesis. Type of primary neoplasm had no significant influence on success rate. The 30-day mortality rate was 16.7% (n = 17). Survival curves after 180 days showed significant differences, with best survival in mesothelioma and shortest life expectancy in lung cancer (p = 0.005). Adverse effects included empyema in one case and malignant invasion of the scar. No episode of talc-induced ARDS was observed.

Conclusion

Thoracoscopic talc pleurodesis is a safe and effective method to stop recurrent MPEs. Lasting pleural symphysis is obtained.

Section snippets

Patients

One hundred two consecutive patients with documented rapidly recurrent MPE (57 men and 45 women; median age, 66 years; age range, 20 to 83 years) who underwent medical thoracoscopy and TTP between January 1999 and December 2001 were included. Only those patients who were judged to be capable of undergoing this procedure were enrolled in the study. The patients with a poor performance status who were unable to care for themselves were excluded from the procedure. Chest radiography and thoracic

Results

One hundred two patients were treated within the 3-year survey period. The presenting symptom in the majority of patients (86.3%) was dyspnea. Also common was cough (22.5%) and thoracic pain (23.5%) as secondary symptoms. The characteristics of the study population are noted in Table 1. The main tumor types were lung cancer (n = 48), breast cancer (n = 16), and malignant pleural mesothelioma (n = 10), and the remainder was a heterogeneous group of malignancies. Median duration of suction

Discussion

In symptomatic patients with recurrent MPE of known or unknown etiology, medical thorascopy and TTP is recommended.1, 13, 14, 15 Talc is superior to other agents in producing pleurodesis,16 but the clinical success rate of TTP varies, and the safety of this procedure is currently being intensively discussed. Therefore, we conducted this analysis in order to address both issues.

Unfortunately, the definition of success, as well as the length of follow-up, differs in the literature, which

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