Tumor Type Influences the Effectiveness of Pleurodesis in Malignant Effusions

Abstract

Pleurodesis is commonly indicated for symptom relief in patients with malignant pleural effusions. A number of factors may influence pleurodesis outcome, but whether tumor type is one of them is a matter of debate. This study investigates the impact of tumor type on the efficacy of bedside doxycycline and thoracoscopic talc poudrage pleurodesis in order to determine which patients may benefit most from these procedures. A retrospective study of 138 and 450 doxycycline and talc poudrage pleurodesis procedures, respectively, evaluated their overall successes and failures, according to primary tumor types. In addition, a logistic regression model addressed whether the pleurodesis outcome in different tumor types was influenced by or attributable to pleural tumor burden. In the talc group, patients with lung cancer and mesothelioma had significantly lower complete response rates (63 and 61%, respectively) as compared with breast (77%) and other metastatic effusions (74%, p = 0.012). In the doxycycline group, the data followed the same trend in that complete response rates were lower in patients with lung carcinomas (31%) than in those with breast cancer (54%) or metastases from other primary sites (74%, p = 0.001). The regression analysis showed pleural burden and tumor type as independent predictors of pleurodesis failure in the talc group. The tumor type involving the pleural surfaces influences the success of a pleurodesis, regardless of the sclerosing agent used. Malignant effusions due to mesothelioma and lung cancer are particularly prone to a failed procedure.

Mechanisms of Pleurodesis

“…A potential explanation could be that a trapped lung is relatively common in mesothelioma and metastatic tumors of the lung as a result of either visceral pleural restriction (mesothelioma) or endobronchial obstruction (lung cancer). Also, we found that a high tumor burden in the pleural space was negatively associated with the results of pleurodesis [34]. This indicates that the likelihood of achieving a successful pleurodesis decreases with an increasing pleural tumor burden observed during thoracoscopy.…”

Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): an open-label, randomised, controlled trial

“…23,24 Studies of talc pleurodesis efficacy focusing specifically on patients with mesothelioma seem to have lower success rates than studies in heterogeneous populations, probably because extensive visceral disease, common in mesothelioma, mitigates against successful pleurodesis because of failure of visceral and parietal pleura apposition combined with a paucity of normal mesothelial cells. 25,26 A retrospective study 27 of 165 patients with malignant pleural mesothelioma who underwent pleurodesis reported that pleural effusion was not controlled in 31% of patients, with no difference between talc slurry and talc poudrage. At the inception of our trial, the predominant method for assessing pleural effusion was chest radiograph-a less sensitive method than ultrasound, which is now widely used.…”

Symptom Management in Metastatic Breast Cancer

“…Pleurodesis with doxycycline or talc may be indicated for symptom relief, as well as serial thoracenteses or even the placement of a PleurX catheter for palliative management in patients who are not suitable for pleurodesis [73,74].…”