Video-Assisted Talc Pleurodesis for Malignant Pleural Effusions Utilizing Local Anesthesia and IV Sedation

Danby, Christopher A.; Adebonojo, Samuel A.; Moritz, Dennis

doi:10.1378/chest.113.3.739

Cited by 66 publications

(32 citation statements)

References 7 publications

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“…Patients with lung cancer, the largest subgroup of MPE patients, have been reported to have lower rates of success, although this trend was not substantiated in the current study. Danby et al 34 noted that all failures in their series were lung cancer patients. In some patients, the lung may become "trapped" by tumor or fibrin, a condition that commonly leads to pleurodesis failure.…”

Section: Discussionmentioning

confidence: 97%

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

Dresler

Olak

Herndon³

et al. 2005

Chest

518

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: 97%

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

Dresler

Olak

Herndon³

et al. 2005

Chest

518

376

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“…While rapid [20] as well as outpatient [21] pleurodesis has been advocated, length of stay (LOS) was not reported in the rapid study and success rate was only 48%, whereas only 10 patients were studied in the outpatient report, which has yet to be replicated. LOS following thoracoscopy is frequently said to be short but often not clearly reported in studies [3,4,22,23]. Published data suggests mean duration of chest tube drainage of 3-7 days [2,[22][23][24] and LOS of 7-8 days [2,24].…”

Section: Discussionmentioning

confidence: 99%

“…LOS following thoracoscopy is frequently said to be short but often not clearly reported in studies [3,4,22,23]. Published data suggests mean duration of chest tube drainage of 3-7 days [2,[22][23][24] and LOS of 7-8 days [2,24]. Interestingly, drainage time and LOS following thoracoscopical procedures does not appear to be shorter than chest tube pleurodesis in controlled studies [23,24].…”

Section: Discussionmentioning

confidence: 99%

Use of tunnelled catheters for malignant pleural effusions in patients fit for pleurodesis

Tremblay¹,

Mason²,

Michaud³

2007

Eur Respir J

110

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The aim of the present study was to examine the effectiveness of tunnelled pleural catheters (TPC) in patients with malignant pleural effusions who would otherwise be candidates for pleurodesis.Patients were selected from a previously reported database of 250 TPC insertions. The study group was selected based on lung re-expansion and survival as a surrogate maker of eligibility for pleurodesis procedure, as defined by survival of o90 days and lung re-expansion o80% postdrainage on a standard chest radiograph 2 weeks post TPC placement.There were 109 procedures in 97 patients that met the entry criteria. Spontaneous pleurodesis (SP) was achieved following 70% of procedures and correlated with symptom control. The mean time to SP was 90 days. There was no need for a repeat procedure in 87% of cases overall and in 92% of patients experiencing SP. There were few complications and no procedure-related deaths.Tunnelled pleural catheters are an effective way of controlling malignant pleural effusions when used as first-line treatment in patients who appear to be candidates for pleurodesis procedures.

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“…Some centres described thoracoscopic procedures under local anaesthesia and intravenous sedation [22,23]; in these studies, sedation was obtained by intravenous administration of propofol and fentanyl. This technique requires the permanent assistance of an anaesthetist in many countries.…”

Section: Safety and Feasibility Of Thoracoscopy Under Local Anaesthesiamentioning

confidence: 99%

Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion

Rodríguez-Panadero

Janssen²,

Astoul³

2006

Eur Respir J

154

111

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Video-Assisted Talc Pleurodesis for Malignant Pleural Effusions Utilizing Local Anesthesia and IV Sedation

Cited by 66 publications

References 7 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

Use of tunnelled catheters for malignant pleural effusions in patients fit for pleurodesis

Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion

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