Prospective Randomized Trial of Talc Slurry vs Bleomycin in Pleurodesis for Symptomatic Malignant Pleural Effusions*

Zimmer, Peter; Hill, Mark; Casey, Kenneth R.; Harvey, Eric; Low, Donald E.

doi:10.1378/chest.112.2.430

Cited by 142 publications

(101 citation statements)

References 24 publications

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“…Stage IV lung cancer confers a poor prognosis, particularly when it co-occurs with pleural effusion (14). In recent years, there have been advancements in techniques that can preserve lung function, such as talc pleurodesis (12). The identification of genetic mutations associated with lung cancer (EGFR, anaplastic lymphoma receptor tyrosine kinase and ROS proto-oncogene 1 receptor tyrosine kinase) and the availability of biological drugs that are less toxic, better tolerated and more effective is improving the prognosis of patients with lung cancer, at least in the short term (5-7).…”

Section: Discussionmentioning

confidence: 99%

“…The presence of pleural effusion, a common manifestation of NSCLC, worsens the prognosis of patients (12,13). The management of pleural effusions is crucial for improving the patient's quality of life and prognosis (12).…”

Section: Discussionmentioning

confidence: 99%

“…The management of pleural effusions is crucial for improving the patient's quality of life and prognosis (12). Talc pleurodesis is a relatively new method for treating recurrent pleural effusions and is less invasive than other methods (12,14). Pleurodesis can limit the spread of NSCLC and the development of respiratory failure (15).…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, in wild-type EGFR patients, EGFR TKIs treatment was less effective when administered alone compared with chemotherapy (5)(6)(7)(8)(9)(10)(11). In patients with lung cancer with metastatic disease of the pleura, pleurodesis with talc has been utilized as an integrated treatment option to inhibit the drainage of pleural fluid and preserve lung function, improving the patient's quality of life (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Lung cancer requires multidisciplinary treatment to improve patient survival: A case report

Pezzuto¹,

Terzo

Graziani

et al. 2017

Oncology Letters

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Abstract. The present study reports two cases of lung cancer with the involvement of the pleura. The diagnosis of adenocarcinoma with epidermal growth factor receptor (EGFR) mutation was made following repeated thoracentesis with cytology of pleural fluid and thoracoscopy with pleural biopsies. Talc pleurodesis was successfully performed in both cases subsequent to diagnosis. Following talc pleurodesis, the first patient (62 years old; male; non-smoker) underwent 3 cycles of cisplatin/vinorelbine chemotherapy, with a poor response. Concurrently, due to the presence of an EGFR mutation, treatment with gefitinib was initiated, with the patient achieving a good response for ~12 months. The residual tumor was treated with stereotactic radiotherapy and the patient continued gefitinib treatment. The patient is presently in good health, has not exhibited any signs of relapse and is continuing gefitinib treatment without side effects. The second patient (53 years old; male ex-smoker) underwent treatment with gefitinib subsequent to talc pleurodesis for a total of 15 months. In addition, radiotherapy (60 Gy) on the residual lesion was performed. Subsequently, second-line therapy with cisplatin/premetrexed was prescribed and followed by maintenance treatment with premetrexed. Three years after diagnosis, the patient did not exhibit any signs of recurrence. These two cases highlight the difficulty in treating advanced stage lung cancer, despite the presence of EGFR mutation. Each lung cancer is different and requires the physician to possess a wide range of knowledge of the therapeutic options available, in addition to careful monitoring in order to adjust the treatment over time. A multidisciplinary approach, involving surgeons, radiation oncologists, pulmonologists and oncologists, is required to optimize the survival and quality of life of patients with lung cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lung cancer requires multidisciplinary treatment to improve patient survival: A case report

Pezzuto¹,

Terzo

Graziani

et al. 2017

Oncology Letters

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“…Shaw et al in their Cochrane meta-analysis showed that talc was associated with a significantly better chance of success than any other agent [1]. A prospective, randomized trialconcluded that bleomycin is as effective as talc, but the agent iscostly [20]. A meta-analysis comparing talc, bleomycin, tetracycline/ doxycycline, C. parvum extract, and mitozatrone did not find one agent that was significantly better than the others, although the trend was toward better success with talc [21].…”

Section: Discussionmentioning

confidence: 99%

Pleurodesis in malignant pleural effusions: Outcome and predictors of success

Rafei¹,

Jabak²,

Mina³

et al. 2015

Integr Cancer Sci Therap

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Malignant pleural effusion is a common clinical problem in cancer patients. Many therapeutic techniques have been investigated, including pleurodesis. Little is known about the factors that may affect the success rate of such a procedure. The main objective of this study is to assess the success rates of pleurodesis performed on malignant pleural effusions in cancer patients at AUBMC and to identify the predictors of a successful pleurodesis. Patients diagnosed with malignant pleural effusions and who have undergone pleurodesis between years 2004 and 2013 at the American University of Beirut Medical Center were identified. Relevant information including patient, tumor and pleural effusion characteristics and outcome after pleurodesis was recorded. Data analysis was done to assess the success rate of pleurodesis as well as for the presence of statistically significant association between success of pleurodesis and the different clinical characteristics. Pleurodesis success rates were as follow: 17.7% had complete success, 12.9% had partial success, 40.3% had failed pleurodesis, 3.2% died shortly after pleurodesis, and 25.8% were lost to follow-up. When this failure rate was further analyzed in terms of the different clinical markers, only two parameters were found to be associated with different success rates of pleurodesis, namely the mean pH of the pleural fluid and the tube used to perform pleurodesis. The conclusions of this study will benefit future cancer patients presenting with malignant effusions. Based on this study's results a well as those of future studies, clinicians will cautiously plan the management of malignant pleural effusion and also refine the technique used.

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A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions

Putnam

Light

Rodriguez

et al. 1999

Cancer

352

219

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Prospective Randomized Trial of Talc Slurry vs Bleomycin in Pleurodesis for Symptomatic Malignant Pleural Effusions*

Cited by 142 publications

References 24 publications

Lung cancer requires multidisciplinary treatment to improve patient survival: A case report

Lung cancer requires multidisciplinary treatment to improve patient survival: A case report

Pleurodesis in malignant pleural effusions: Outcome and predictors of success

A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions

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