Pleurodesis in recurrent pleural effusions: a randomized comparison of a classical and a currently popular drug

Ukale, Valiant; Agrenius, Veronica; Hillerdal, Gunnar; Mohlkert, Dag; Widström, O

doi:10.1016/j.lungcan.2003.09.014

Cited by 32 publications

(17 citation statements)

References 15 publications

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“…This might be explained by both less fluid recurrence and better overall survival. This finding supports the recommendation of systemic therapy in several guidelines (table 1) and data from other studies [14,25]. This recommendation is not supported with a high level of evidence, but the present data also emphasise the benefit of pleurodesis when a new line of systemic treatment is about to be commenced.…”

Section: Discussionsupporting

confidence: 82%

Pleural drainage and pleurodesis: implementation of guidelines in four hospitals

Burgers¹,

Kunst²,

Koolen³

et al. 2008

European Respiratory Journal

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The aim of the present study was to evaluate the implementation of the 2003 Dutch guideline on the diagnosis and treatment of malignant pleural effusions, and the potential effect of the implementation on the clinical outcome of pleurodesis.All patients with malignant pleural effusion who had a pleural drain placed with the intention of performing pleurodesis were registered prospectively in four centres. Details of the procedure and fluid recurrence and survival data were noted.Patients with a proven malignancy (n5100) were entered into the registration database. Diagnostic guideline recommendations were followed in 60-70% of the patients. Surprisingly, pleurodesis was performed in only 75% of the patients, mainly due to the presence of a trapped lung. All pleurodeses were performed using talc, according to the guideline. Follow-up revealed fluid recurrence in 27 (36%) patients after a mean follow-up of 17 days (range 2-285 days); 14 patients with successful pleurodesis died with a median survival of 61 days (range 13-174 days). Systemic treatment following pleurodesis and good apposition of the pleural surfaces during drainage were good prognostic factors.Despite reasonable-to-good adherence to the guideline, the number of successful pleurodeses was low. Better predictors of a good pleurodesis outcome are needed.

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Section: Discussionsupporting

confidence: 82%

Pleural drainage and pleurodesis: implementation of guidelines in four hospitals

Burgers¹,

Kunst²,

Koolen³

et al. 2008

European Respiratory Journal

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“…Instillation of the sclerosing agent is thereafter followed by a profound inflammatory response between the layers, which, in turn, result in fibrin accumulation and pleural fibrosis. A variety of different chemicals (talc, bleomycin, tetracycline, iodopovide and others) and bacterial products (from Corynobactum parvum, Streptococcus pyogenes, Staphylococcus aureus and others) have been used in clinical studies to achieve pleurodesis [70][71][72][73]. The profound inflammatory response they cause may result in adverse events such as pain and fever but it is believed that the level of inflammation correlates with the likelihood of successful pleurodesis [74].…”

Section: Pleurodesismentioning

confidence: 99%

Malignant pleural effusion: from bench to bedside

et al. 2016

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Malignant pleural effusion (MPE) is a common but serious condition that is related with poor quality of life, morbidity and mortality. Its incidence and associated healthcare costs are rising and its management remains palliative, with median survival ranging from 3 to 12 months. During the last decade there has been significant progress in unravelling the pathophysiology of MPE, as well as its diagnostics, imaging, and management. Nowadays, formerly bed-ridden patients are genotyped, phenotyped, and treated on an ambulatory basis. This article attempts to provide a comprehensive overview of current advances in MPE from bench to bedside. In addition, it highlights unanswered questions in current clinical practice and suggests future directions for basic and clinical research in the field. @ERSpublications This review provides up to date knowledge for malignant pleural effusion covering aspects from bench to bedside http://ow.ly/10w7vN

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“…(Table ) Talc is the most commonly used agent worldwide . Tetracycline derivatives, cytotoxic agents such as bleomycin, OK432 (a preparation of Streptococcus pyogenes type A3 commonly reported in Japanese studies) and quinacrine (an antimalarial agent used in Scandinavian studies) are some of the alternative agents used. Iodopovidone and silver nitrate have been shown, albeit in small trials, to have comparable efficacy as talc poudrage for MPE control, with few complications.…”

Section: Interventional Therapies In Mpementioning

confidence: 99%

Interventional therapies for malignant pleural effusions: The present and the future

et al. 2014

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The approach to management of malignant pleural effusions (MPE) has changed over the past few decades. The key goals of MPE management are to relieve patient symptoms using the least invasive means and in the most cost-effective manner. There is now a realization that patient-reported outcome measures should be the primary goal of MPE treatment, and this now is the focus in most clinical trials. Efforts to minimize patient morbidity are complemented by development of less invasive treatments that have mostly replaced the more aggressive surgical approaches of the past. Therapeutic thoracentesis is simple, effective and generally safe, although its benefits may only be temporary. Pleurodesis is the conventional and for a long time the only definitive therapy available. However, the efficacy and safety of talc pleurodesis has been challenged. Indwelling pleural catheter (IPC) drainage is increasingly accepted worldwide and represents a new concept to improve symptoms without necessarily generating pleural symphysis. Recent studies support the effectiveness of IPC treatment and provide reassurance regarding its safety. An unprecedented number of clinical trials are now underway to improve various aspects of MPE care. However, choosing an optimal intervention for MPE in an individual patient remains a challenge due to our limited understanding of the underlying pathophysiology of breathlessness in MPE and a lack of predictors of survival and pleurodesis outcome. This review provides an overview of common pleural interventional procedures used for MPE management, controversies and limitations of current practice, and areas of research most needed to improve practice in future.

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Pleurodesis in recurrent pleural effusions: a randomized comparison of a classical and a currently popular drug

Cited by 32 publications

References 15 publications

Pleural drainage and pleurodesis: implementation of guidelines in four hospitals

Pleural drainage and pleurodesis: implementation of guidelines in four hospitals

Malignant pleural effusion: from bench to bedside

Interventional therapies for malignant pleural effusions: The present and the future

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