Pleurodesis for malignant pleural effusions

Shaw, Paul; Agarwal, Roshan

doi:10.1002/14651858.cd002916.pub2

Cited by 300 publications

(238 citation statements)

References 42 publications

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“…A Cochrane review reported that pleurodesis with talc provided the highest relative chance of MPE nonrecurrence when compared with bleomycin, tetracycline, mustine or chest-tube drainage alone [24]. Because talc is not commercially available in Japan, other sclerosing agents (i.e.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of pleurodesis for malignant pleural effusions in breast cancer patients

Hirata¹,

Yonemori

Hirakawa³

et al. 2011

Eur Respir J

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This study retrospectively compared long-term outcomes between two groups of breast cancer patients with malignant pleural effusion (MPE): those receiving only systemic therapy (ST) and those receiving ST following initial pleurodesis (P-ST).We identified 180 breast cancer patients from the National Cancer Center Hospital (Tokyo, Japan) database who had received ST and P-ST as an initial treatment for MPE between 1997 and 2008 for study inclusion. Pleural progression-free survival (PPFS) was defined as the time from ST in the ST group and from pleurodesis in the P-ST group to the first observation of pleural progression or death from any cause.Of the 180 patients, 78 received ST and 102 received P-ST after MPE diagnosis. Median duration of follow-up was 12.7 months (range 0.9-80.1 months). Median PPFS for the ST group and the P-ST group was 4.1 and 8.5 months, respectively. The difference in PPFS between the two groups was statistically significant (p,0.001) and the hazard ratio after adjusting for prognostic factors in the P-ST group relative to the ST group was 0.24.Our results suggest that the efficacy of P-ST may be superior to that of ST alone with respect to local control of pleural effusions in breast cancer patients.

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Section: Discussionmentioning

confidence: 99%

Efficacy of pleurodesis for malignant pleural effusions in breast cancer patients

Hirata¹,

Yonemori

Hirakawa³

et al. 2011

Eur Respir J

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“…1,4 Talc is widely recognized as the sclerosant agent of choice in view of its clinical effi cacy, safety profi le, and low cost, whereas thoracoscopic talc pleurodesis has been suggested as the most effective pleurodesis technique. 2,3,5 In fact, during video-assisted thoracoscopy, pleural fl uid can be removed completely, loculations and adhesions can be divided when present, and talc can be insuffl ated equally in the pleural space under visual control.…”

Section: Discussionmentioning

confidence: 99%

“…Two recent systematic reviews 2,3 found that the relative risk for successful pleurodesis favored talc over other sclerosants and suggested that thoracoscopic talc poudrage was the technique of choice for pleurodesis in patients with MPE.…”

Section: Introductionmentioning

confidence: 99%

Suitable device for thoracoscopic talc poudrage in malignant pleural effusion

Billè

Borasio

Gisabella

et al. 2011

Gen Thorac Cardiovasc Surg

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Chemical pleurodesis is widely used in symptomatic patients with malignant pleural effusion to relieve symptoms, prevent fl uid recurrence, and improve quality of life. Talc has been repeatedly found to be the most effective sclerosant agent, and thoracoscopic talc poudrage has been found to be the most effective pleurodesis technique. A homogeneous talc distribution on the visceral and parietal pleura helps to achieve complete pleural symphysis. We have recently adopted a new suitable sterile device that delivers talc under low and constant pressure, facilitating uniform coating of the whole pleural surface and avoiding inappropriate deposition of talc clumps.

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“…The available evidence supports the need for chemical sclerosants for successful pleurodesis; using talc as the sclerosant of choice (5 g of sterile talc) and thoracoscopic pleurodesis as the preferred technique for pleurodesis, based on efficacy. There is no evidence for an increase in mortality following talc pleurodesis [194,195]. In a large series of 611 patients, CARDILLO et al [196] showed that perioperative mortality was less than 1% and morbidity 3%.…”

Section: Malignant Pleural Effusion and Malignant Pericardial Effusionmentioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

Eur Respir Rev

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Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

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Pleurodesis for malignant pleural effusions

Cited by 300 publications

References 42 publications

Efficacy of pleurodesis for malignant pleural effusions in breast cancer patients

Efficacy of pleurodesis for malignant pleural effusions in breast cancer patients

Suitable device for thoracoscopic talc poudrage in malignant pleural effusion

Surgery for nonsmall cell lung cancer

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