Medical Talc Pleurodesis: Which Patient with Cancer Benefits Least?

Abstract

Background and Objective: Successful talc pleurodesis (TP) for malignant pleural effusion (MPE) gives symptom relief, but may be too exhaustive in cases with poor performance status. The selection of eligible patients is therefore a challenging task. The study was undertaken to evaluate frequency of successful TPs, side effects, complications, performance status, hospitalization time, remaining time alive, and the responsible physician's prediction of a successful TP judged by radiologic findings prior to TP. Methods: Side effects of TPs performed during a 1-year period were consecutively recorded and the TP outcomes were retrospectively evaluated 6 years later. Results: TP success rate was 56% and 79% among best support of care subjects (BSC; n = 10) and subjects eligible for cancer therapy (non-BSC; n = 19), respectively, while side effects did not differ. Performance status was poorer and survival shorter among BSC subjects. Time spent in hospital of the remaining time alive for BSC and non-BSC subjects was 42% -27% and 4% -4%, respectively. Poor performance status of subjects with lung cancer correlated with short survival time, which in turn correlated with many days at hospital for TP. The physician's prediction of a successful TP was correct in 50% of all cases. Conclusions: Performance status of BSC subjects are probably too poor for TP and these subjects have to spend too much time at hospital during the procedure. The responsible physician is able to correctly predict a successful TP outcome in only every second case, supporting the need of additional predictive analysis.

Pleurodesis

“…Finally, it is important to mention that the main benefit of pleurodesis lies in improving the survival of well-selected patients in whom the procedure is successful [157][158][159][160].…”

Predictors of outcome of pleurodesis in patients with malignant pleural effusion: a systematic review and meta-analysis

“…Data from six studies [5,27,32,39,41,43] including 507 participants were combined into meta-analysis and the resultant pooled OR for pleurodesis success with large bore chest tubes was 1.28 (95% CI 0.80 -2.06, p 0.298), I 2 0%, p=0.703 (figure 3A).…”

“…The results of four studies [26,32,42,44] including 269 participants were meta-analysed to provide an OR for successful pleurodesis for patients on active systemic treatment. The pooled OR of successful pleurodesis is 3.11 (95%CI 0.77 -12.54, p=0.111), I 2 77.2%, p 0.004 (figure 4B).…”

Treatment Approaches for Malignant Pleural Effusion

“…First, we are concerned with the subgroup analyses of the hospitalization periods according to baseline characteristics. A difference was previously reported in the success rate with talc pleurodesis between patients with limited long-term prognosis (56%) and patients with longer-term prognosis (79%) . Therefore, for patients with relatively limited-term prognosis, treatment with an indwelling pleural catheter might be preferable to talc pleurodesis.…”