Thoracoscopic Talc Poudrage Pleurodesis for Malignant Effusions

Viallat, J. R.; Rey, F.; Astoul, Philippe; Boutin, C

doi:10.1378/chest.110.6.1387

Cited by 233 publications

(136 citation statements)

References 37 publications

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“…These observations are consistent with some previous reports (although others report no acute respiratory failure in large series 26,27 ). Using 10 g of talc in a slurry, Rinaldo et al 10 reported three cases of ARDS with bilateral infiltrates apparently precipitated by talc.…”

Section: Discussionsupporting

confidence: 94%

Phase III Intergroup Study of Talc Poudrage vs Talc Slurry Sclerosis for Malignant Pleural Effusion

Dresler

Olak

Herndon³

et al. 2005

Chest

506

376

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Study objective-To demonstrate the efficacy, safety, and appropriate mode of instillation of talc for sclerosis in treatment of malignant pleural effusions (MPEs).Design-A prospective, randomized trial was designed to compare thoracoscopy with talc insufflation (TTI) to thoracostomy and talc slurry (TS) for patients with documented MPE.Measurements-The primary end point was 30-day freedom from radiographic MPE recurrence among surviving patients whose lungs initially re-expanded > 90%. Morbidity, mortality, and quality of life were also assessed.Results-Of 501 patients registered, those eligible were randomized to TTI (n = 242) or TS (n = 240). Patient demographics and primary malignancies were similar between study arms. Overall, there was no difference between study arms in the percentage of patients with successful 30-day outcomes (TTI, 78%; TS, 71%). However, the subgroup of patients with primary lung or breast cancer had higher success with TTI than with TS (82% vs 67%). Common morbidity included fever, dyspnea, and pain. Treatment-related mortality occurred in nine TTI patients and seven TS patients. Respiratory complications were more common following TTI than TS (14% vs 6%).Correspondence to: Carolyn Dresler, MD, MPA, Head, Tobacco Unit, International Agency for Research on Cancer, Lyon, France; Carolyn_dresler@ksg03.harvard.edu. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptRespiratory failure was observed in 4% of TS patients and 8% of TTI patients, accounting for five toxic deaths and six toxic deaths, respectively. Quality-of-life measurement demonstrated less fatigue with TTI than TS. Patient ratings of comfort and safety were also higher for TTI, but there were no differences on perceived value or convenience of the procedures. Since that time, a significant number of single institution reports have been published, primarily using thorascopically insufflated talc. However, a growing number of authors have advocated talc slurry via a percutaneously placed chest tube as a simpler and equally effective method for control of MPE with minimal short-term morbidity. However, several reports 10,11 of serious respiratory complications with talc have also been published. Conclusions-BothThe objectives of the current trial Cooperative Groups Cancer and Leukemia Group B (CALGB) 9334 compare tube thoracostomy with talc slurry (TS) to surgical thoracoscopy with talc insufflation (TTI), and assesses their efficacy at 30 days, in addition to the safety and associated quality of life in a randomized multicenter trial. Portions of this work have been presented in abstract form. 12 Materials and MethodsThis was an intergroup cooperative trial led by the CALGB and monitored semiannually by its Data and Safety Monitoring Board, with participation by the Radiation Therapy Oncology Group, the Eastern Cooperative Oncology Group (ECOG), and the North Central Cooperative Oncology Group, encompassing both private and teaching hospitals. Credentialing of participating surgeon...

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Section: Discussionsupporting

confidence: 94%

Phase III Intergroup Study of Talc Poudrage vs Talc Slurry Sclerosis for Malignant Pleural Effusion

Dresler

Olak

Herndon³

et al. 2005

Chest

506

376

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“…TTP combined with closed drainage and simple negative pressure suction is an effective therapy for malignant and refractory benign pleural effusions (55)(56)(57). In our study, TTP was applied through VATS and then closed thoracic drainage combined with simple negative pressure suction was administered to each patient.…”

Section: Discussionmentioning

confidence: 93%

EGFR mutations predict a favorable outcome for malignant pleural effusion of lung adenocarcinoma with Tarceva therapy

Guo

Wan²,

Tian³

et al. 2011

Oncol Rep

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Abstract. The aim of the present study was to evaluate the therapeutic effects and adverse reactions of Tarceva treatment for malignant pleural effusion (MPE) caused by metastatic lung adenocarcinomas. One hundred and twenty-eight patients who failed first-line chemotherapy drug treatment were divided into a mutation and a non-mutation group according to the presence or absence of epidermal growth factor receptor (EGFR) mutations. Each patient received closed drainage combined with simple negative pressure suction after thoracoscopic talc poudrage pleurodesis and oral Tarceva treatment. Short-term and long-term clinical therapeutic effects of Tarceva were evaluated. The EGFR mutation rate in pleural metastatic tissues of lung adenocarcinoma acquired through video-assisted thoracoscopic surgery was higher compared to that in surgical resection specimens, plasma specimens and pleural effusion specimens compared to previously reported results. There were significant statistical differences in the average extubation time (p<0.01), drainage volume of pleural effusion (p<0.05), Karnofsky score and formation of encapsulated pleural effusion 4 weeks after surgery (p<0.05) between these two groups. The number of patients with mild pleural hypertrophy in the mutation group was significantly higher compared to the non-mutation group (p<0.01), while the number of patients with severe pleural hypertrophy was significantly reduced (p<0.05). There was significant statistical discrepancy between these two groups in terms of improvement of peripheral blood carcinoembryonic antigen and tissue polypeptide antigen after 4 weeks of therapy. The complete remission rate and the efficacy rate were higher in the mutation group compared to that in the non-mutation group (p<0.05). There was a longer overall survival time after Tarceva treatment in patients with EGFR mutations than those without EGFR mutation. EGFR mutations predict a favorable outcome for malignant pleural effusion of lung adenocarcinoma with Tarceva therapy. Detection of EGFR mutations may determine the responsiveness of malignant pleural effusion to Tarceva treatment.

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“…Common side effects of talc include fever (10-17%), pain, and gastrointestinal symptoms. Less common side effects include arrhythmia, dyspnea, respiratory failure, a systemic inflammatory response, empyema, and the dissemination of talc to other regions [8][9][10]. However, talc particles and other pro-fibrotic factors hypothetically have the potential to be absorbed and lead to systemic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Pleurodesis with pseudomonas aeruginosa-mannose–sensitive hemagglutinin for pneumothorax secondary to COPD: a retrospective study

Luo

Tan

et al. 2017

COPD Res Pract

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Background: Pneumothorax is a potentially life-threatening complication of chronic obstructive pulmonary disease (COPD) that leads to cardiopulmonary compromise. According to the British Thoracic Society (BTS) guidelines, medical pleurodesis is recommended for inoperable patients suffering from COPD-related pneumothorax. Several sclerosing agents are currently in use, but none have been proven to be the best choice, as each one has effectiveness and safety issues. Recent research has shown that Pseudomonas aeruginosa-mannose-sensitive hemagglutinin (PAMSHA) is a safe bioagent with low toxicity and good immune-boosting effects that can induce the aseptic inflammation necessary to cause pleural adhesion. The aim of this study is to report our experience using PAMSHA in medical pleurodesis to treat inoperable cases of persistent pneumothorax secondary to COPD. Methods: Records of 78 inoperable patients with persistent pneumothorax secondary to COPD treated with PAMSHA pleurodesis were retrospectively reviewed. Pleurodesis was performed by administering 1 ml of PAMSHA (mixed with lidocaine and 30-40 ml of normal saline) intrapleurally. Results: The resolution of pneumothorax was observed in all of the patients treated with PAMSHA pleurodesis (success rate = 100%). Some of them experienced mild chest pain and fever, but no long-term side effects were reported. Conclusion: Our data suggest that PAMSHA pleurodesis is a safe and effective option for the treatment of persistent pneumothorax secondary to COPD.

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Thoracoscopic Talc Poudrage Pleurodesis for Malignant Effusions

Cited by 233 publications

References 37 publications

Phase III Intergroup Study of Talc Poudrage vs Talc Slurry Sclerosis for Malignant Pleural Effusion

Phase III Intergroup Study of Talc Poudrage vs Talc Slurry Sclerosis for Malignant Pleural Effusion

EGFR mutations predict a favorable outcome for malignant pleural effusion of lung adenocarcinoma with Tarceva therapy

Pleurodesis with pseudomonas aeruginosa-mannose–sensitive hemagglutinin for pneumothorax secondary to COPD: a retrospective study

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