Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience

Our plain-English summary of Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience, by J. Leemans, C. Dooms, V. Ninane, et al (Respirology, 2018).

The study

• Authors: J. Leemans, C. Dooms, V. Ninane, J. Yserbyt
• Journal: Respirology
• Published: 2018;23(6):613-617
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Objective: Malignant pleurisy is associated with advanced oncological disease and dyspnoea is the most common presenting symptom. Pleurodesis is the preferred palliative and supportive treatment option, targeting symptom relief. The identification of clinical and endoscopic features that determine the success of talc pleurodesis in malignant pleurisy could guide clinical decision-making.

Methods: All symptomatic patients with malignant pleurisy subjected to talc pleurodesis through medical thoracoscopy between January 2012 and December 2015 were included. Univariate and multivariate analyses were performed to identify factors associated with successful pleurodesis.

Results: Of the 155 patients, 122 (78%) were classified as having a successful pleurodesis based on clinical and radiological criteria. Factors associated with unsuccessful pleurodesis (univariate analysis) were the presence of pleural adhesions (odds ratio (OR): 0.43 (95% CI: 0.19-0.96); P = 0.04), extensive spread of pleural lesions (OR: 0.17 (95% CI: 0.05-0.59); P = 0.001), the use of systemic corticosteroids (OR: 0.28 (95% CI: 0.10-0.83); P = 0.02) and a prolonged time period between the clinical diagnosis of the pleural effusion and the moment of pleurodesis (OR: 0.14 (95% CI: 0.06-0.32); P < 0.0001). The latter being associated with failure of pleurodesis in a multivariate analysis (OR: 0.08 (95% CI: 0.01-0.25); P < 0.0001). Chest ultrasound prior to pleurodesis showed a sensitivity of 91% and a specificity of 88% in predicting the success of pleurodesis.

Conclusion: The success rate of pleurodesis in malignant pleurisy could potentially be enhanced by correct patient selection and early referral for pleurodesis. Ultrasonic assessment of pleural adhesions and potential lung expansion prior to pleurodesis is useful in clinical decision-making.

© 2018 Asian Pacific Society of Respirology.

In plain English

This was a retrospective analysis of a prospectively recruited patient group at one Belgian hospital. It covered 155 people with symptoms from malignant pleurisy, meaning cancer in the lining of the lung causing fluid build-up. All had talc pleurodesis, which seals the space around the lung, through medical thoracoscopy from January 2012 to December 2015. Lung cancer was the most common primary tumour, and 6% had mesothelioma. The study did not examine asbestos exposure. Pleurodesis succeeded in 121 patients and failed in 34. Looked at one at a time, four factors were linked to failure: pleural adhesions, extensive pleural lesions, systemic corticosteroids, and more than 38 days between the first fluid drainage and pleurodesis. A combined analysis tested only clinical factors. In it, the longer interval stayed linked to failure, but the corticosteroid link was not confirmed. In 30 patients scanned in 2015, chest ultrasound predicted incomplete lung expansion with 91% sensitivity and 88% specificity. The authors concluded that early referral could potentially improve success. They noted the retrospective design and the lack of a validation series as limits.

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 observational analysis of a prospectively recruited single-centre patient cohort
• Who was studied: 155 symptomatic patients with cytologically or histologically confirmed malignant pleurisy who had thoracoscopic talc pleurodesis at University Hospitals KU Leuven, Belgium, between January 2012 and December 2015. Of 172 patients treated, 17 without symptoms were excluded. Median age was 67 years and 55% were female. Primary tumours were bronchopulmonary carcinoma (45%), mammary carcinoma (22%), ovarian cancer (10%), digestive carcinoma (9%), mesothelioma (6%) and other origin (8%).
• Exposure: No asbestos exposure was studied. The intervention studied was talc pleurodesis through medical thoracoscopy, and the study looked for clinical and endoscopic factors linked to its success or failure.
• Main results:
  • Among the 155 symptomatic patients, 121 (78%) had successful pleurodesis and 34 had unsuccessful pleurodesis, judged by clinical and radiological criteria.
  • In univariate analysis (odds ratios for success over failure), the following were associated with failure: systemic corticosteroids, OR 0.28 (95% CI 0.10–0.83), P = 0.02; an interval of more than 38 days between thoracocentesis and pleurodesis, OR 0.14 (95% CI 0.06–0.32), P < 0.0001; pleural adhesions, OR 0.43 (95% CI 0.19–0.96), P = 0.04; and extensive pleural lesions, OR 0.17 (95% CI 0.05–0.59), P = 0.001.
  • The multivariate analysis included clinical parameters only, so the endoscopic findings (pleural adhesions and extensive pleural lesions) were not in it. An interval of more than 38 days was associated with failed pleurodesis (Table 1: OR 0.07, 95% CI 0.02–0.22, P < 0.0001). The corticosteroid association was not confirmed (OR 0.33, 95% CI 0.10–1.11, P = 0.08).
  • Pleural adhesions were more frequent in patients with an interval of more than 38 days between first thoracocentesis and pleurodesis: OR 2.7 (95% CI 1.2–5.9), P = 0.02.
  • Median survival was 169 days in the successful-pleurodesis group and 66 days in the failed group. Successful pleurodesis was associated with lower mortality: HR 0.52 (95% CI 0.30–0.91), P = 0.02.
  • The authors cautioned that the longer survival seen with successful pleurodesis should not be read as showing that talc pleurodesis gives a survival benefit.
  • In the 30 patients who had chest ultrasound (M-mode) before pleurodesis in 2015, ultrasound predicted incomplete lung expansion after pleurodesis with a sensitivity of 91% and a specificity of 88%.
  • Among the failed pleurodeses, the post hoc cause most often identified was trapped lung, in 15 subjects (43%).
  • Procedure-related complications occurred in nine patients (6%): six (5%) in the successful group and three (9%) in the failed group.
• The authors' conclusion: The authors concluded that their survey endorses early referral for talc pleurodesis in symptomatic patients with malignant pleurisy, as this could potentially enhance the success rate.
• Limitations the authors state:
  • The study was retrospective and had no validation series.
  • Ultrasound data before pleurodesis were available only for a subset of patients, those treated in 2015.
  • Scoring of the ultrasound clips depends on the operator.

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: Medical Thoracoscopy, Talc Pleurodesis, Pleurisy, Pleurodesis, Palliative Care, Odds Ratio, Pleural Effusion, Multivariate Analysis.

Related studies

• Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series — D.C. Mares, P.N. Mathur (1998)
• Tumor type influences the effectiveness of pleurodesis in malignant effusions — S. Bielsa, P. Hernández, et al. (2011)
• Clinically important associations of pleurodesis success in malignant pleural effusion: Analysis of the TIME1 data set — R.M. Mercer, J. Macready, et al. (2020)
• Survival in patients with malignant pleural effusion undergoing talc pleurodesis — M. Hassan, R.M. Mercer, et al. (2019)
• Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis — M. Yeung, E.W. Loh, et al. (2020)
• Talc Pleurodesis: A Medical, Medicolegal, and Socioeconomic Review — I. Baiu, E. Yevudza, et al. (2020)

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