Skip to main content

Main menu

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Subscribers
    • Advertisers
    • Editorial Board
  • Other Publications
    • In Vivo
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
    • 2008 Nobel Laureates
  • About Us
    • General Policy
    • Contact
  • Other Publications
    • Anticancer Research
    • In Vivo
    • Cancer Genomics & Proteomics

User menu

  • Register
  • Subscribe
  • My alerts
  • Log in
  • Log out
  • My Cart

Search

  • Advanced search
Anticancer Research
  • Other Publications
    • Anticancer Research
    • In Vivo
    • Cancer Genomics & Proteomics
  • Register
  • Subscribe
  • My alerts
  • Log in
  • Log out
  • My Cart
Anticancer Research

Advanced Search

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Subscribers
    • Advertisers
    • Editorial Board
  • Other Publications
    • In Vivo
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
    • 2008 Nobel Laureates
  • About Us
    • General Policy
    • Contact
  • Visit us on Facebook
  • Follow us on Linkedin
Research ArticleClinical Studies

Improved Quality of Life in Patients with Malignant Pleural Effusion Following Videoassisted Thoracoscopic Talc Pleurodesis. Preliminary Results

STEFANO M.M. BASSO, FRANCESCO MAZZA, BERNARDO MARZANO, DAVIDE A. SANTEUFEMIA, GIORDANO B. CHIARA and FRANCO LUMACHI
Anticancer Research November 2012, 32 (11) 5131-5134;
STEFANO M.M. BASSO
1Surgery I, S. Maria degli Angeli Hospital, Pordenone, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: drsteba@tin.it
FRANCESCO MAZZA
2Pneumology, S. Maria degli Angeli Hospital, Pordenone, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
BERNARDO MARZANO
1Surgery I, S. Maria degli Angeli Hospital, Pordenone, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
DAVIDE A. SANTEUFEMIA
3Medical Oncology, S. Maria degli Angeli Hospital, Pordenone, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
GIORDANO B. CHIARA
1Surgery I, S. Maria degli Angeli Hospital, Pordenone, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
FRANCO LUMACHI
4Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, School of Medicine, Padova, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Malignant pleural effusion (MPE) is a common, debilitating complication of several types of advanced malignancy, which may significantly reduce the quality of life of patients. There are several options to treat MPE, including thoracentesis, placement of a long-term indwelling pleural catheter and chemical pleurodesis. The best treatment is still debated, but talc remains the agent of choice to achieve pleurodesis. Forty-six patients (28 men and 18 women; median age 67 years, range 47-82 years) with MPE related to different malignancies underwent video-assisted thoracoscopy talc pleurodesis. There were 26 (56.5%) patients with non-small cell lung cancer, 8 (17.4%) with breast cancer, 7 (15.2%) with pleural mesothelioma and 5 (10.9%) with other malignancies. The average operative time was 28±8 minutes, and the duration of chest tube drainage was 9.4±4.1 days. Side-effects were mild (temporary pain, fever for 2-3 days), affecting only three (12%) patients. Two patients (8%) died during hospitalization, due to progression of disease. Overall, pre- and postoperative Karnofsky performance index (KI) and Medical Research Council (MRC) dyspnea score were 62.1±12.2 vs. 71.3±13.2 (p=0.014), and 4.2±0.8 vs. 2.7±1.0 (p<0.001), respectively. A significant relationship between total amount of preoperative pleural effusion and both KI (R=−0.54, p=0.002) and MRC (R=0.64, p=0.0001) was found. No correlation (p=NS, log-rank test) was found between preoperative KI or MRC and underlying malignancy related to MPE. In conclusion, thoracoscopic large-particle talc pleurodesis is a feasible and effective treatment for MPE, significantly improving quality of life of patients.

  • Malignant pleural effusion
  • quality of life
  • talc pleurodesis
  • advanced cancer
  • thoracoscopy
  • VATS

Advanced cancer is frequently complicated by malignant pleural effusion (MPE), which significantly reduces the quality of life (QoL) of patients (1, 2). There are several options to treat MPE, including thoracentesis, placement of a long-term indwelling pleural catheter (IPC) and chemical pleurodesis. The best treatment is still debated, but the goal is always to achieve successful relief of symptoms (3, 4).

Talc has long been considered one of the safest, cheapest and most effective agents for promoting pleural symphysis, although cases of acute respiratory distress syndrome and of respiratory failure following talc pleurodesis have been reported (5, 6). The Medical Research Council (MRC) dyspnea score and Karnofsky performance index (KI) are reliable QoL indicators, useful in evaluating results of treatment for MPE (7, 8).

The purpose of this study was to analyze the usefulness of talc pleurodesis in improving QoL of patients with cancer and symptomatic MPE.

Patients and Methods

Study population. Forty-six patients (median age 67 years, range 47-82 years) with MPE related to different malignancies underwent video-assisted thoracoscopy (VATS) and pleurodesis with large-particle (mean size 25 μm) talc (Steritalc, Novatech, France), administered by a pneumatic atomizer. There were 26 (56.5%) patients with lung cancer, 8 (17.4%) with breast cancer, 7 (15.2%) with pleural mesothelioma and 5 (10.9%) with other malignancies (Table I). Patients with pulmonary infection, unstable respiratory status, cardiac failure, trapped lung syndrome and poor performance status (KI≤30) were excluded from the study. All participants gave written informed consent for participation in accordance with local Ethical Committee guidelines. Patients were asked to report their functional limitations by filling the MRC and KI questionnaires before surgery and at discharge. VATS was performed under general anesthesia, with careful aspiration of pleural effusion and division of adhesions. A chest tube was inserted after thoracoscopy and removed when the daily output was less than 50 ml. The amount of pleural effusion was measured and recorded in a database, together with pre- and postoperative KI and MRC score, age of the patients and duration of chest tube drainage.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table I.

Main characteristics of the study population.

Statistical analysis. The reported data are expressed as the mean±standard deviation (SD). Differences between means were tested by Student's t-test, while the relationship between pairs of variables was determined using Pearson's correlation coefficient (R) calculation and the log-rank test for dichotomous variables. Each association was considered statistically significant when the p-value was <0.01.

Results

The average duration of VATS was 28±8 minutes, and the duration of chest tube drainage was 9.4±4.1 days. Side-effects were mild: temporary local pain, fever for 2-3 days and cellulitis. Three patients (6.5%) died during hospitalization due to progression of disease.

Overall, the pre- and postoperative KI and MRC score were 62.1±12.2 vs. 71.3±13.2 (p=0.014), and 4.2±0.8 vs. 2.7±1.0 (p<0.001), respectively. Table II reports the correlation found between parameters. A significant relationship between the total amount of preoperative pleural effusion and both KI (R=−0.54, p=0.002) and MRC (R=0.64, p=0.0001) was found (Figure 1). No correlation (p=NS, log-rank test) was found between pre- and postoperative KI or MRC scores and the underlying malignancy related to MPE.

Discussion

Pleural effusion is a common, debilitating complication of several types of advanced malignancy. The presence of MPE indicates a poor prognosis, with a median survival of patients ranging from 3 to 12 months (1, 9). MPE is more frequently associated with lung cancer and advancer breast carcinoma, followed by ovarian cancer, lymphomas and other malignancies (10). Usually, dyspnea and cough greatly affect the QoL of patients with MPE. Thus, relief of symptoms and prevention of pleural effusion reaccumulation represent the main goal of treatment. Thoracentesis is the essential first step, but is associated with recurrence in at least 90% of patients within 30 days from the procedure (11). Chest tube drainage, pleurodesis by either VATS or thoracostomy with talc slurry, and intrapleural chemotherapy are the commonest therapeutic options for treating MPE (12).

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Relationship between amount of pleural drainage (ml), preoperative Medical Research Council (MRC) dyspnea score and Karnofsky performance index.

Obliteration of the pleural cavity can be achieved through extensive adhesion of the visceral and parietal pleura, induced by several sclerosing agents (13). Talc remains the agent of choice to obtain pleurodesis and is currently recommended by the British Thoracic Society (BTS) 2010 guidelines (14). Talc, magnesium silicate ([Mg3Si4]10[OH]2), has been used for pleurodesis in the treatment of many pleural diseases, such as benign and malignant pleural effusion and spontaneous pneumothorax, since the first half of the 20th century (6, 15, 16). The use of large-particle talc is usually considered safe and BTS guidelines suggest talc pleurodesis as the first-line treatment for patients with symptomatic MPE, having limited side-effects (14). Several studies confirmed its higher success rate and a lower complication rate as compared to other techniques (5, 6, 11). The use of IPC should be reserved for patients with trapped lung or unsuccessful talc pleurodesis (14). However, the heterogeneity among patients with MPE makes the adoption of a single approach difficult (17).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table II.

Pearson's correlation coefficient (R) and respective p-value between parameters.

In the decision-making process, the impact of MPE on QoL, type and stage of the underlying cancer, performance status and patient preferences should be considered (18). In a multicentric study comparing talc poudrage vs. talc slurry, both methods of talc delivery obtained similar outcomes (78% vs. 71%, p=NS), without any significant benefit of one technique over the other (19). Thoracoscopic talc poudrage is a painless procedure and has the advantage of complete evacuation of the cavity, allowing pleural adhesions to resolve and lung or pleural biopsies to be performed, if needed. However, in patient selection, the risk of single-lung ventilation should be considered.

The reported short-term (1-3 months) and 6-month success rate of VATS talc insufflation ranges from 85% to 89% and from 82% to 83%, respectively (11, 20). Successful pleurodesis is clearly related to a marked improvement in dyspnea. In our series, both KI and MRC scores improved significantly (p<0.01) after the procedure and were related to the amount of preoperative pleural effusion. More recently, Davies et al. (21) did not find any significant difference in visual analog scale dyspnea scores between first-line talc pleurodesis and IPC, in the management of MPE. IPC was associated with several adverse events, but did reduce the length of hospitalization (21).

In conclusion, our preliminary data confirm that VATS talc pleurodesis is a feasible and effective treatment for MPE, impacting favorably on the QoL of patients with MPE, and representing the method of choice for improving dyspnea and chest pain, which are the principal goals of care for such patients. The relationship between total pre-operative pleural effusion and QoL is somewhat obvious, but interesting, thus suggesting the advantages of early treatment of MPE in the majority of such patients.

Footnotes

  • ↵* Presented at the European Society of Medical Oncology (ESMO) Third European Lung Conference (ELCC), Geneva, Switzerland, 18-21 April, 2012.

  • Received August 28, 2012.
  • Revision received October 9, 2012.
  • Accepted October 10, 2012.
  • Copyright© 2012 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved

References

  1. ↵
    1. Burrows CM,
    2. Mathews WC,
    3. Colt HG
    : Predicting survival in patients with recurrent symptomatic malignant pleural effusions: An assessment of the prognostic values of physiologic, morphologic, and quality of life measures of extent of disease. Chest 117: 73-78, 2000.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Pilling JE,
    2. Dusmet ME,
    3. Ladas G,
    4. Goldstraw P
    : Prognostic factors for survival after surgical palliation of malignant pleural effusion. J Thorac Oncol 5: 1544-1550, 2010.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Haas AR,
    2. Sterman DH,
    3. Musani AI
    : Malignant pleural effusions: Management options with consideration of coding, billing, and a decision approach. Chest 132: 1036-1041, 2007.
    OpenUrlCrossRefPubMed
  4. ↵
    1. van den Toorn LM,
    2. Schaap E,
    3. Surmont VF,
    4. Pouw EM,
    5. van der Rijt KC,
    6. van Klaveren RJ
    : Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter. Lung Cancer 50: 123-127, 2005.
    OpenUrlCrossRefPubMed
  5. ↵
    1. de Campos JR,
    2. Varga FS,
    3. de Campos Werebe E,
    4. Cardoso P,
    5. Teixeira LR,
    6. Jatene FB,
    7. Light RW
    : Thoracoscopy talc poudrage. A 15-year experience. Chest 119: 801-806, 2001.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Janssen JP,
    2. Collier G,
    3. Astoul P,
    4. Tassi GF,
    5. Noppen M,
    6. Rodriguez-Panadero F,
    7. Loddenkemper R,
    8. Herth FJ,
    9. Gasparini S,
    10. Marquette CH,
    11. Becke B,
    12. Froudarakis ME,
    13. Driesen P,
    14. Bolliger CT,
    15. Tschopp JM
    : Safety of pleurodesis with talc poudrage in malignant pleural effusion: A prospective cohort study. Lancet 369: 1535-1539, 2007.
    OpenUrlCrossRefPubMed
  7. ↵
    1. Bestall JC,
    2. Paul EA,
    3. Garrod R,
    4. Garnham R,
    5. Jones PW,
    6. Wedzicha JA
    : Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 54: 581-586, 1999.
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Manali ED,
    2. Stathopoulos GT,
    3. Kollintza A,
    4. Kalomenidis I,
    5. Emili JM,
    6. Sotiropoulou C,
    7. Daniil Z,
    8. Roussos C,
    9. Papiris SA
    : The Medical Research Council chronic dyspnea score predicts the survival of patients with idiopathic pulmonary fibrosis. Respir Med 102: 586-592, 2008.
    OpenUrlCrossRefPubMed
  9. ↵
    1. Lombardi G,
    2. Zustovich F,
    3. Nicoletto MO,
    4. Donach M,
    5. Artioli G,
    6. Pastorelli D
    : Diagnosis and treatment of malignant pleural effusion: A systematic literature review and new approaches. Am J Clin Oncol 33: 420-423, 2010.
    OpenUrlPubMed
  10. ↵
    1. Antunes G,
    2. Neville E,
    3. Duffy J,
    4. Ali N
    : BTS guidelines for the management of malignant pleural effusions. Thorax 58: ii29-38, 2003.
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Barbetakis N,
    2. Asterious C,
    3. Papadopoulou F,
    4. Samanidis G,
    5. Paliouras D,
    6. Kleontas A,
    7. Lyriti K,
    8. Katsikas I,
    9. Tsilikas C
    : Early and late morbidity and mortality and life expectancy following thoracoscopic talc insufflations for control of malignant pleural effusions: A review of 400 cases. J Cardiothorac Surg 5: 27-33, 2010.
    OpenUrlCrossRefPubMed
  12. ↵
    1. Chen H,
    2. Brahmer J
    : Management of malignant pleural effusion. Curr Oncol Rep 10: 287-293, 2008.
    OpenUrlCrossRefPubMed
  13. ↵
    1. Rodriguez-Panadero F,
    2. Montes-Worboys A
    : Mechanisms of pleurodesis. Respiration 83: 91-98, 2012.
    OpenUrlCrossRefPubMed
  14. ↵
    1. Roberts ME,
    2. Neville E,
    3. Berrisford RG,
    4. Antunes G,
    5. Ali NG
    : Management of a malignant pleural effusion. British Thoracic Society Pleural Disease Guideline 2010. Thorax 65: ii32-ii40, 2010.
    OpenUrlFREE Full Text
  15. ↵
    1. Bethune N
    : Pleural poudrage: New technique for the deliberate production of pleural adhesion as preliminary to lobectomy. J Thorac Surg 4: 251-261, 1935.
    OpenUrl
  16. ↵
    1. Weissberg D,
    2. Ben-Zeev I
    : Talc pleurodesis: Experience with 360 patients. J Thorac Cardiovasc Surg 106: 689-695, 1993.
    OpenUrlPubMed
  17. ↵
    1. Maskell NA
    : Treatment options for malignant pleural effusions. Patient preference does matter. JAMA 307: 2432-2433, 2012.
    OpenUrlPubMed
  18. ↵
    1. Doelken P
    : Management of pleural effusion in the cancer patient. Semin Respir Crit Care Med 31: 734-742, 2010.
    OpenUrlPubMed
  19. ↵
    1. Dresler CM,
    2. Olak J,
    3. Herndon JE II.,
    4. Richards WG,
    5. Scalzetti E,
    6. Fleishman SB,
    7. Kernstine KH,
    8. Demmy T,
    9. Jablons DM,
    10. Kohman L,
    11. Daniel TM,
    12. Haasler GB,
    13. Sugarbaker DJ
    : Phase III intergroup study of talc poudrage vs. talc slurry sclerosis for malignant pleural effusion. Chest 127: 909-915, 2005.
    OpenUrlCrossRefPubMed
  20. ↵
    1. Kolschmann S,
    2. Ballin A,
    3. Gillissen A
    : Clinical efficacy and safety of thoracoscopic talc pleurodesis in malignant pleural effusions. Chest 128: 1431-1435, 2005.
    OpenUrlCrossRefPubMed
  21. ↵
    1. Davies HE,
    2. Mishra EK,
    3. Kahan BC,
    4. Wrightson JM,
    5. Stanton AE,
    6. Guhan A,
    7. Davies CW,
    8. Grayez J,
    9. Harrison R,
    10. Prasad A,
    11. Crosthwaite N,
    12. Lee YC,
    13. Davies RJ,
    14. Miller RF,
    15. Rahman NM
    : Effect of an indwelling pleural catheter vs. chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: The TIME2 randomized controlled trial. JAMA 307: 2383-2389, 2012.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Anticancer Research: 32 (11)
Anticancer Research
Vol. 32, Issue 11
November 2012
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Back Matter (PDF)
  • Ed Board (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Anticancer Research.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Improved Quality of Life in Patients with Malignant Pleural Effusion Following Videoassisted Thoracoscopic Talc Pleurodesis. Preliminary Results
(Your Name) has sent you a message from Anticancer Research
(Your Name) thought you would like to see the Anticancer Research web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
8 + 2 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Improved Quality of Life in Patients with Malignant Pleural Effusion Following Videoassisted Thoracoscopic Talc Pleurodesis. Preliminary Results
STEFANO M.M. BASSO, FRANCESCO MAZZA, BERNARDO MARZANO, DAVIDE A. SANTEUFEMIA, GIORDANO B. CHIARA, FRANCO LUMACHI
Anticancer Research Nov 2012, 32 (11) 5131-5134;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Reprints and Permissions
Share
Improved Quality of Life in Patients with Malignant Pleural Effusion Following Videoassisted Thoracoscopic Talc Pleurodesis. Preliminary Results
STEFANO M.M. BASSO, FRANCESCO MAZZA, BERNARDO MARZANO, DAVIDE A. SANTEUFEMIA, GIORDANO B. CHIARA, FRANCO LUMACHI
Anticancer Research Nov 2012, 32 (11) 5131-5134;
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Patients and Methods
    • Results
    • Discussion
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Quality of life after interventions for malignant pleural effusions: a systematic review
  • British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma
  • Assessment of patient-reported outcome measures in pleural interventions
  • Google Scholar

More in this TOC Section

  • Pelvic Recurrence After Curative Resection for Rectal Adenocarcinoma: Impact of Surgery on Survival
  • Glasgow Prognostic Score Predicts Survival and Recurrence Pattern in Patients With Hepatocellular Carcinoma After Hepatectomy
  • Small Bowel Lipomatosis: An Unusual Radiological Finding in Patients With Renal Cell Cancer on Pazopanib
Show more Clinical Studies

Similar Articles

Keywords

  • Malignant pleural effusion
  • quality of life
  • talc pleurodesis
  • advanced cancer
  • thoracoscopy
  • VATS
Anticancer Research

© 2023 Anticancer Research

Powered by HighWire