Background: Malignant pleural effusions can cause severe debilitating symptoms and impair the quality of life. Treatment is often palliative, usually consisting of sequential thoracenteses or tube thoracostomy with or without sclerotherapy. Large-bore thoracostomy tubes have traditionally been used for drainage and sclerotherapy. More recently, the use of small-bore catheters has been studied. Objectives: To assess the efficacy and safety of small-bore catheter (Pleuracan®) thoracostomy combined with talc sclerotherapy for palliative treatment of malignant pleural effusions. Methods: Between May 1998 and March 2000, 24 consecutive patients presenting at our inpatient clinic were studied. Follow-up radiography at the end of the 1st month (immediate response) and 3rd month (long-term follow-up) after talc pleurodesis was performed to assess the response rates. Results: Of the 24 patients included, 2 patients did not show lung expansion after pleural drainage. Two patients died within 30 days after talc pleurodesis and 1 did not undergo 30-day postpleurodesis radiography. The remaining 19 patients made up the study group to assess the response rates (8 men, 11 women). Overall response rates of talc pleurodesis via small-bore catheter were found to be 84.2% [complete response (CR): 68.4%, partial response (PR): 15.8%] at 30-day and 78.6% (CR: 57.2%, PR:2 1.4%) at 90-day follow-up, respectively. One patient reported moderate pain during catheter placement. Four patients experienced mild to moderate pleuritic chest pain, shortness of breath, or both within 4 h after instillation. Seven of the 22 patients (31.8%) had a transient fever (≤39.0°C) 6–24 h after talc instillation that lasted less than 24 h and was successfully treated with acetaminophen. One patient had significant subcutaneous emphysema that resolved in 24 h. Four patients died because of tumor progress (2 patients in the 1st month and 2 patients between 30 and 90 days). Conclusion: Pleurodesis can successfully be performed via a small-bore catheter in patients with recurrent malignant pleural effusion. To validate the results of the study, a prospective randomized study, comparing this device (Pleuracan) and a ‘standard’ 16- to 24-french chest drain, should be performed.

Keywords:
Pleurodesis, Catheter, small-bore, Talc, Pleural effusion, malignant
1.
Tattersall M: Pleural effusions. Curr Opin Oncol 1992;4:642–646.
2.
Lynch TJ: Management of malignant pleural effusions. Chest 1993;103:385–389.
3.
Patz EF Jr: Malignant pleural effusions: Recent advances and ambulatory sclerotherapy. Chest 1998;113:74–77.
4.
Grossi F, Penucci MC, Tixi L, Cafferata MA, Ardizzoni A: Management of malignant pleural effusions. Drugs 1988;55:47–58.
5.
Morrison MC, Mueller PR, Lee MJ, et al: Sclerotherapy for malignant pleural effusion through sonographically placed small-bore catheters. Am J Roentgenol 1992;158:41–43.
6.
Reinhold C, Illescas FF, Atri M, Bret PM: Treatment of pleural effusions and pneumotorax with catheters placed percutaneously under image guidance. Am J Roentgenol 1989;152:1189–1191.
7.
Merriam MA, Cronan JJ, Dorfman GS, Lambiase RE, Haas RA: Radiographic guided percutaneous catheter drainage of pleural fluid collections. Am J Roentgenol 1988;151:1113–1116.
8.
Parker LA, Charnock GC, Delany DJ: Small-bore catheter drainage and sclerotherapy for malignant pleural effusions. Cancer 1989;64:1218–1221.
9.
Jacobi CA, Wenger FA, Schmitz-Rixen T, Muller JM: Talc pleurodesis in recurrent pleural effusions. Langenbecks Arch Surg 1998;383:156–159.
10.
Kennedy L, Sahn SA. Talc pleurodesis for the treatment of pneumothorax and pleural effusion. Chest 1994;106:1215–1222.
11.
Webb WR, Özmen V, Moulder PV, Shabahang B, Breaux J: Iodized talc pleurodesis for the treatment of pleural effusions. J Thorac Cardiovasc Surg 1992;103:881–886.
12.
Kennedy L, Rusch VW, Strange C, et al: Pleurodesis using talc slurry. Chest 1994;106:342–346.
13.
Turler A, Gawenda M, Walter M: Palliative iodized talc pleurodesis with instillation via tube thoracostomy. Support Care Cancer 1997;5:61–63.
14.
Walter M, Turler A, Schmitz-Rixen T: Talc pleurodesis in recurrent malignant pleural effusion – A prospective follow-up study. Zentralbl Chir 1996;121:216–222.
15.
Seaton KG, Patz EF Jr, Goodman PC: Palliative treatment of malignant pleural effusions: Value of small-bore catheter thoracostomy and talc sclerotherapy. Am J Roentgenol 1995;164:589–591.
16.
Anderson CB, Philpott GW, Ferguson TB: The treatment of malignant pleural effusions. Cancer 1974;33:916–922.
17.
Ruckdeschel JC: Management of malignant pleural effusions. Semin Oncol 1995;22:58–63.
18.
Hausheer RH, Yarbro JW: Diagnosis and treatment of malignant pleural effusion. Semin Oncol 1985;12:54–75.
19.
Austin EH, Flye MW: The treatment of recurrent malignant effusion. Ann Thorac Surg 1979;28:190–203.
20.
Goff BA, Mueller PR, Muntz HG, et al: Small chest-tube drainage followed by bleomycin sclerosis for malignant pleural effusion. Obstet Gynecol 1993;81:993–996.
21.
Walsh FW, Alberts WM, Solomon DA, Goldman AL: Malignant pleural effusions: Pleurodesis using a small-bore percutaneous catheter. South Med J 1989;82:963–965.
22.
Van Le L, Parker LA, Demars LR, et al: Pleural effusion: Outpatient management with pigtail catheter chest tubes. Gynecol Oncol 1994;54:215–217.
23.
Patz EF, McAdams HP, Goodman PC, et al: Ambulatory sclerotherapy for malignant pleural effusions. Radiology 1996;199:133–135.
24.
Marom EM, Patz EF Jr, Erasmus JJ, McAdams HP, Goodman PC, Herndon JE: Malignant pleural effusions: Treatment with small-bore-catheter thoracostomy and talc pleurodesis. Radiology 1999;210:277–281.
25.
Thompson RL, Yau JC, Donnelly RF, Gowan DJ, Matzinger FR: Pleurodesis with iodised talc for malignant effusions using pigtail catheters. Ann Pharmacother 1998;32:739–742.
26.
Vialat J, Rey F, Astoul P, Boutin C: Thoracoscopic talc poudrage pleurodesis for malignant effusions: A review of 360 cases. Chest 1996;110:1387–1393.
27.
Tatersall M: Management of malignant pleural effusions. Aust NZ J Med 1998;28:394–396.
28.
Walker-Renard PB, Vaughan LM, Sahn SA: Chemical pleurodesis for malignant pleural effusion. Ann Intern Med 1994;120:56–64.
29.
Schafers SJ, Dresler CM: Update on talc, bleomycin, and the tetracyclines in the treatment of malignant pleural effusions. Pharmacotherapy 1995;15:228–235.
30.
Clementsen P, Evald T, Grode G, Hansen M, Krag Jacobsen G, Faurschou P: Treatment of malignant pleural effusion: Pleurodesis using a small percutaneous catheter. A prospective randomized study. Respir Med 1998;92:593–596.
31.
Rinaldo JE, Owens GR, Rogers RM: Adult respiratory distress syndrome following intrapleural instillation of talc. J Thorac Cardiovasc Surg 1983;85:523–526.
© 2001 S. Karger AG, Basel
2001
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.