Pleurodesis outcome in malignant pleural mesothelioma

Our plain-English summary of Pleurodesis outcome in malignant pleural mesothelioma, by E.T. Fysh, S.K. Tan, C.A. Read, et al (Thorax, 2013).

The study

• Authors: E.T. Fysh, S.K. Tan, C.A. Read, F. Lee, K. McKenzie, N. Olsen, I. Weerasena, T. Threlfall, N. de Klerk, A.W. Musk, Y.C. Lee
• Journal: Thorax
• Published: 2013;68(6):594-6
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Few data exist on the pleurodesis outcome in patients with malignant pleural mesothelioma (MPM). A retrospective review of the Western Australian Mesothelioma Registry over 5 years revealed 390 evaluable patients. Only a subset of patients (42.3%) underwent pleurodesis, surgically (n=78) or by bedside instillation of sclerosants (n=87). Surgical pleurodesis showed no advantages over bedside pleurodesis in efficacy (32% vs 31% failures requiring further drainage, p=0.98), patient survival (p=0.52) or total time spent in hospital from procedure till death (p=0.36). No clinical, biochemical or radiographic parameters tested adequately predict pleurodesis outcome.

In plain English

This study looked back at patients with malignant pleural mesothelioma (a cancer of the lining around the lung) recorded in the Western Australian Mesothelioma Registry over five years from August 2004. The authors reviewed hospital records for 390 patients to see how well pleurodesis worked. Pleurodesis is a procedure meant to seal the chest lining so fluid stops building up. It was attempted in 165 patients (42.3%): 78 by surgery and 87 at the bedside. Overall, 29.7% had complete success, 38.8% partial success, and 31.5% failed and needed more drainage. Failure rates were 32.1% after surgical and 31.0% after bedside pleurodesis (p=0.98). Survival and hospital days did not differ significantly between the two methods. Fluid size on x-ray, fluid chemistry and tumour subtype did not predict the outcome. The authors concluded that success rates were suboptimal and that surgical pleurodesis offered no advantage over bedside pleurodesis. They noted that the study was retrospective and that surgical patients were younger and treated earlier. The article did not study asbestos exposure.

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: Retrospective review of a statewide mesothelioma registry and hospital medical records
• Who was studied: 390 patients with proven malignant pleural mesothelioma (86% men, mean age 70) with accessible teaching-hospital records, from the Western Australia Mesothelioma Registry, over a 5-year period from 1 August 2004
• Exposure: Not an asbestos exposure study. The comparison was between treatments: surgical pleurodesis (talc poudrage during video-assisted thoracoscopy, pleuroscopy or thoracotomy) versus bedside instillation of talc or bleomycin
• Main results:
  • Pleurodesis was attempted in 165 of the 390 patients (42.3%): 78 by surgery, 86 by bedside talc and 1 by bedside bleomycin
  • Among the 165 patients treated with pleurodesis, complete success was 29.7%, partial success 38.8% and failure needing further drainage 31.5%
  • Success rates did not differ between surgical and bedside pleurodesis (failure 32.1% vs 31.0%, p=0.98). There were also no differences in survival (p=0.52) or total hospital days (19.0 vs 23.0 median days, p=0.36)
  • Median survival was longer in patients who underwent pleurodesis than in those who did not: 443 vs 318 days (p=0.002)
  • Effusion size on x-ray, pleural fluid biochemistry and mesothelioma histological subtype did not predict pleurodesis outcome
  • Patients whose pleurodesis failed spent more days in hospital than those with complete or partial success (median 25.0 vs 18.0 days, p=0.03)
  • 92 further pleural procedures were performed on the 52 patients in whom pleurodesis failed
  • Four patients died within 14 days of attempted pleurodesis, none related to the procedure. Empyema (an infection in the chest cavity) occurred in five patients (3.0%)
• The authors' conclusion: The authors concluded that pleurodesis success rates in malignant pleural mesothelioma were suboptimal, that surgical pleurodesis provided no advantage over bedside pleurodesis, and that no parameter studied adequately predicted failure
• Limitations the authors state:
  • The study was retrospective, so clinical management and surgical approaches were not standardised, and the groups were not randomised
  • The surgical group was younger and had pleurodesis earlier, which the authors describe as biases

Topics

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

Medical terms in this study, explained in our Lexicon: Pleurodesis, Pleural Mesothelioma, Mesothelioma.

Related studies

• Tumor type influences the effectiveness of pleurodesis in malignant effusions — S. Bielsa, P. Hernández, et al. (2011)
• Can serum inflammatory parameters estimate outcome of pleurodesis in mesothelioma? — M. Bilgin, L. Hasdiraz, et al. (2007)
• Survival in patients with malignant pleural effusion undergoing talc pleurodesis — M. Hassan, R.M. Mercer, et al. (2019)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• CT appearances of talc pleurodesis — S. Narayanaswamy, S. Kamath, et al. (2007)
• Prognostic factors in malignant pleural mesothelioma: role of talc pleurodesis — B.S. Al-Alao, H. Parissis, et al. (2012)

Browse more research in Thorax, or return to medical research.