Treatment of recurrent malignant pleural effusion by iodized talc pleurodesis

Jones, Gwyneth

doi:10.1136/thx.24.1.69

Cited by 68 publications

(20 citation statements)

References 12 publications

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“…Reported 30-day mortality in previous studies varies considerably, from 0 to 32% for TS 19,21 and from 3 to 24% for TTI. 22,23 In some studies, lower mortality corresponds to a high percentage of breast cancer and higher mortality to a preponderance of lung cancer in the case mix. However, Kennedy and colleagues 24 reported 24% (14 of 58 patients) 30-day mortality despite a large percentage of patients with breast cancer.…”

Section: Discussionmentioning

confidence: 99%

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

Dresler

Olak

Herndon³

et al. 2005

Chest

507

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: Discussionmentioning

confidence: 99%

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

Dresler

Olak

Herndon³

et al. 2005

Chest

507

376

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“…The intrapleural administration of talc creates an intensely reactive obliterative pleuritis which is highly effective (>90%) in controlling recurrent malignant pleural effusion [1,80,81,[117][118][119][120][121][122][123][124][125][126][127]. The risk of significant complications associated with this agent in unselected patients make it less desirable than bleomycin or tetracycline.…”

Section: Talcmentioning

confidence: 99%

Diagnosis and treatment of malignant pleural effusion

1987

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Pleural effusion is a common and important complication of malignancy which may at times be difficult to diagnose or treat. Its well recognized association with numerous diseases plus the limitations of our usual diagnostic tests may occasionally cause difficulty. In the oncology patient there are a number of common medical problems associated with the development of pleural effusion which frequently coexist with the malignancy. Pleural effusion may be a presenting or late sign of cancer, and when recurrent can be a vexing symptomatic problem. Fortunately, an increasing number of effective diagnostic and therapeutic modalities are available which, when judiciously applied, facilitate our approach.

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“…Six months later, the process evolves into a chronic inflammatory response leading to pleural fibrosis. 16 This process leads to imaging findings independent of the underlying malignant disease process. The CT features of talc pleurodesis consist of pleural areas of very high attenuation (mean CT attenuation values ranging from 140 to 380 HU), with single or multiple focal, nodular, or linear plaquelike areas of thickening, representing talc deposits and associated granulomatous reaction with hyaline fibrosis.…”

Section: Pleurodesismentioning

confidence: 99%