Tumor type influences the effectiveness of pleurodesis in malignant effusions

Our plain-English summary of Tumor type influences the effectiveness of pleurodesis in malignant effusions, by S. Bielsa, P. Hernández, F. Rodriguez-Panadero, et al (Lung, 2011).

The study

• Authors: S. Bielsa, P. Hernández, F. Rodriguez-Panadero, T. Taberner, A. Salud, J.M. Porcel
• Journal: Lung
• Published: 2011;189(2):151-5
• Cited by: 45 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pleurodesis is commonly indicated for symptom relief in patients with malignant pleural effusions. A number of factors may influence pleurodesis outcome, but whether tumor type is one of them is a matter of debate. This study investigates the impact of tumor type on the efficacy of bedside doxycycline and thoracoscopic talc poudrage pleurodesis in order to determine which patients may benefit most from these procedures. A retrospective study of 138 and 450 doxycycline and talc poudrage pleurodesis procedures, respectively, evaluated their overall successes and failures, according to primary tumor types. In addition, a logistic regression model addressed whether the pleurodesis outcome in different tumor types was influenced by or attributable to pleural tumor burden. In the talc group, patients with lung cancer and mesothelioma had significantly lower complete response rates (63 and 61%, respectively) as compared with breast (77%) and other metastatic effusions (74%, p = 0.012). In the doxycycline group, the data followed the same trend in that complete response rates were lower in patients with lung carcinomas (31%) than in those with breast cancer (54%) or metastases from other primary sites (74%, p = 0.001). The regression analysis showed pleural burden and tumor type as independent predictors of pleurodesis failure in the talc group. The tumor type involving the pleural surfaces influences the success of a pleurodesis, regardless of the sclerosing agent used. Malignant effusions due to mesothelioma and lung cancer are particularly prone to a failed procedure.

In plain English

This retrospective study at two Spanish hospitals asked whether cancer type affects pleurodesis success. Pleurodesis seals the space around the lung to stop fluid returning. It covered 126 patients given doxycycline in Lleida and 447 given talc during thoracoscopy in Sevilla. Asbestos was not studied; mesothelioma was one cancer type. With talc, failure rates were 24% for mesothelioma and 15% for lung cancer, versus 7.5% for breast cancer and 9% for other cancers spread to the pleura (p = 0.012). With doxycycline, complete response rates were 31% for lung cancer, 54% for breast cancer and 74% for cancers spread from sites other than lung or breast (p = 0.001). Only one doxycycline patient had mesothelioma. After allowing for the amount of pleural tumor, breast cancer and cancers spread from sites other than lung or breast still did better with talc than mesothelioma. Lung cancer did not differ significantly from mesothelioma, and more pleural tumor was linked to more failures. The authors concluded that tumor type influences pleurodesis success but should not alone be used to deny the procedure. They noted possible bias from the retrospective design.

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 consecutive patients at two hospitals, with logistic regression in the talc group
• Who was studied: Patients with large malignant pleural effusions causing breathlessness. There were 126 patients (138 procedures) treated with doxycycline at Arnau de Vilanova University Hospital, Lleida, Spain, 2001–2009, and 447 patients (450 procedures) treated with talc at Virgen del Rocio University Hospital, Sevilla, Spain, 1982–2008.
• Exposure: No asbestos exposure was studied. The factors compared were cancer type (mesothelioma, lung, breast, and other cancers spread to the pleura) and the pleurodesis agent: 500 mg doxycycline through a chest catheter, or 4–6 g talc blown in during thoracoscopy.
• Main results:
  • Talc group, first procedure: failure rates were 15% for lung cancer and 24% for mesothelioma, compared with 7.5% for breast cancer and 9% for other cancers spread to the pleura (p = 0.012).
  • Talc group: complete response rates were 63% for lung cancer and 61% for mesothelioma, compared with 77% for breast cancer and 74% for other cancers spread to the pleura (p = 0.012).
  • Doxycycline group: complete response rates were 54% for breast cancer, 74% for other non-lung metastatic tumors (cancers spread from sites other than lung or breast) and 31% for lung cancer (p = 0.001).
  • Talc group, mesothelioma: of 66 patients, 16 (24.2%) had failure, 10 (15.2%) partial response and 40 (60.6%) complete response. The doxycycline group had only 1 mesothelioma patient, whose pleurodesis failed.
  • Talc group, regression allowing for pleural tumor burden, odds ratios for pleurodesis success compared with mesothelioma: breast 3.28 (95% CI 1.24–8.63, p = 0.02); other non-lung, non-breast metastases 2.65 (95% CI 1.21–5.82, p = 0.02); lung cancer 1.69 (95% CI 0.76–3.75, p = 0.19, not statistically significant).
  • Talc group: higher pleural tumor burden was linked to lower success (odds ratio 0.81, 95% CI 0.68–0.98, p = 0.03). Failure was 10.3% in 58 patients with burden scores of 1–3 and 19.8% in 116 patients with scores of 7–9 (p = 0.02).
  • Overall, complete plus partial response to the first procedure was 78.6% in the doxycycline group and 87.7% in the talc group.
• The authors' conclusion: The authors concluded that the type of tumor involving the pleura influences the likelihood of successful pleurodesis with either talc poudrage or doxycycline. They found outcomes worse with lung cancer or mesothelioma and apparently better with breast or ovarian cancer. They said this information should not be used alone to deny pleurodesis but may help in selecting patients.
• Limitations the authors state:
  • The retrospective design could have introduced some biases, although patients were recruited consecutively.
  • The findings cannot be applied to other pleurodesis procedures or agents.
  • The authors could not guarantee that the lung had fully re-expanded before every pleurodesis. Decisions relied on plain chest X-ray rather than CT.
  • Other possible predictors, such as pleural fluid pH, were not evaluated. Whether the lower pleural pH in mesothelioma affects doxycycline could not be answered because too few such patients were included.

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: Pleurodesis, Pleural Effusion, Talc, Tumor Burden, Lung Cancer, Mesothelioma, Carcinoma.

Related studies

• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• Survival in patients with malignant pleural effusion undergoing talc pleurodesis — M. Hassan, R.M. Mercer, et al. (2019)
• Predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion — E.T.H. Fysh, S. Bielsa, et al. (2015)
• Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis — M. Yeung, E.W. Loh, et al. (2020)
• Video-assisted management of malignant pleural effusion in breast carcinoma — R. Gasparri, F. Leo, et al. (2006)
• Mechanisms of pleurodesis — F. Rodriguez-Panadero, A. Montes-Worboys (2012)

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