Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series

Our plain-English summary of Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series, by D.C. Mares, P.N. Mathur (Chest, 1998).

The study

• Authors: D.C. Mares, P.N. Mathur
• Journal: Chest
• Published: 1998;114(3):731-5
• Cited by: 69 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Study Objectives: Recurrent chylothorax as a complication of lymphoma has had unsatisfactory outcomes. Serial thoracentesis, tube thoracostomy, and pleurodesis via chest tube have been ineffective and compromise the nutritional and immune status of the patient. Medical thoracoscopic talc pleurodesis has been safe and effective in the treatment of some other varieties of recurrent pleural effusions. Our objective was to investigate the safety and efficacy of medical thoracoscopic talc pleurodesis in the palliation of chylothorax related to lymphoma.

Design: This is a report of 24 hemithoraces treated in 19 consecutive patients with lymphoma-related chylothorax, failing chemotherapy or radiation therapy. The average patient age was 55 years.

Interventions: Medical thoracoscopy was performed under local anesthesia and conscious sedation in a bronchoscopy suite. Sedation included midazolam (mean dose, 6 mg; range, 2-14 mg) with either meperidine (mean dose, 94 mg; range 25-140 mg), or morphine (mean dose, 18 mg; range 4-40 mg). Pleurodesis was performed with insufflation of sterile asbestos-free talc, (4-8 g). After pleurodesis, chest tubes were placed, with the mean duration of chest tube placement being 4 days, range 3 to 10 days.

Results: One patient died a few days after the procedure due to causes related to the primary disease process. Follow-up was for at least 90 days following the procedure. Patients were assessed at 30, 60, and 90 days following the procedure. At each of these endpoints, all patients remaining alive were without recurrence of pleural effusions, which was confirmed by chest radiography. Eight patients in the series died of the effects of their malignancy during the 90-day evaluation interval. Complications included medication reactions in two patients (8.3%) and ARDS in one patient (4.1%).

Conclusion: Many patients with lymphoma-related chylothorax are refractory to chemotherapy and/or radiation therapy. In this group, medical thoracoscopic talc pleurodesis has an acceptable complication rate and a 100% success rate in the prevention of recurrence of pleural effusions at 30, 60, and 90 days following the procedure.

In plain English

This case series from Indiana University Medical Center described 19 patients treated between November 1989 and January 1997 for chylothorax, a buildup of milky lymph fluid around the lungs, caused by lymphoma that had not responded to radiation and/or chemotherapy. Five had fluid on both sides, so 24 sides of the chest were treated. Doctors used a scope, under local anesthesia and sedation, to spray 4 to 8 g of sterile asbestos-free talc into the chest lining to seal the space. The study did not examine asbestos exposure. Among patients still alive, no treated side had fluid return on chest X-ray at 30 days (23 of 23), 60 days (21 of 21) or 90 days (17 of 17). By 90 days, 12 of 19 patients were alive, and the authors related the deaths to the patients' cancers. One patient developed ARDS, a serious lung complication the authors believed was related to the talc, and recovered. Two had medication reactions. The authors concluded the procedure was effective and safe for relieving symptoms, while noting their small number of patients.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case series (single-center, consecutive patients)
• Who was studied: 19 patients (24 hemithoraces; five with bilateral disease) with lymphoma-related chylothorax failing radiation and/or chemotherapy, treated November 1989 to January 1997 at Indiana University Medical Center. Average age 55 years (range 18-75), male to female ratio 1:1. 18 had lymphoma; 1 had chronic lymphocytic leukemia and adenocarcinoma of the colon.
• Exposure: Not an asbestos exposure study. The intervention was medical thoracoscopic pleurodesis with 4 to 8 g of sterile asbestos-free talc, under local anesthesia and conscious sedation.
• Main results:
  • At 30 days, 18 of 19 patients were alive and 23 of 23 treated hemithoraces had no recurrence of pleural effusion on chest radiography.
  • At 60 days, 16 patients remained, and all 21 of their treated hemithoraces were without recurrence.
  • At 90 days, 12 patients were alive, and all 17 of their treated hemithoraces were free of recurrence on chest radiography.
  • The authors related the high attrition of patients to their underlying malignancies.
  • Chest tubes stayed in for an average of 4 days (range 3-10 days).
  • One patient developed ARDS, which the authors believed was related to talc pleurodesis. That patient was extubated on the fifth day after the procedure and recovered.
  • There were two minor complications, which the authors believed were related to the sedation medications: confusion in one patient, and a short ICU stay for hypoxemia and hypoventilation in another. The minor complication rate was 8.3% and the major complication rate was 4.1%.
  • One patient died several days after the procedure from causes related to the primary malignancy.
• The authors' conclusion: The authors concluded that, in patients with lymphoma-related chylothorax refractory to chemotherapy and/or radiation, medical thoracoscopic talc pleurodesis had an acceptable complication rate and a 100% success rate in preventing recurrence of pleural effusions at 30, 60 and 90 days.
• Limitations the authors state:
  • The authors suggested that their ARDS rate of 4.1% may be overestimated because of their small population.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc Pleurodesis, Thoracentesis, Pleurodesis, Pleural Effusion, Chemotherapy, Medical Thoracoscopy, Bronchoscopy, Asbestos-Free Talc.

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