Video-assisted management of malignant pleural effusion in breast carcinoma

Our plain-English summary of Video-assisted management of malignant pleural effusion in breast carcinoma, by R. Gasparri, F. Leo, G. Veronesi, et al (Cancer, 2006).

The study

• Authors: R. Gasparri, F. Leo, G. Veronesi, T. De Pas, M. Colleoni, P. Maisonneuve, G. Pelosi, V. Galimberti, L. Spaggiari
• Journal: Cancer
• Published: 2006;106(2):271-6
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Advanced breast carcinoma almost always leads to a malignant pleural effusion, conditioning the performance status of patients and consequently quality of life. The treatment of malignant pleural effusion should be a priority in the management of such patients. The results of video-thoracoscopic approach (VATS) chemical pleurodesis was analyzed in patients with recurrent pleural effusion from breast carcinoma.

Methods: From October 1998 to June 2004, 71 consecutive patients with breast carcinoma-related pleural effusion were treated by the same thoracic-surgeon team with intracavitary nebulization of 8 g of asbestos-free sterilized talc via VATS. Multiple pleural biopsies were performed to determine biologic characteristics of recurrent disease.

Results: Talc pleurodesis was performed in all cases, with no intraoperative or postoperative complications. Median length of hospital stay was 5 days (range, 5-8). The overall success rate of the surgical procedure was 89% (confidence interval [CI], 79-95%) with a mean follow-up of 22 months (range, 2-81 mos). The overall survival time was 17 months (range, 2-80). Biopsies showed a switch on receptor status and c-erB-2 status from negative (primary tumor) to positive (pleural metastasis) in 11 (15%) patients. In another 7 (9.8%) patients, we obtained completely new information that was hitherto unknown.

Conclusion: Talc pleurodesis via VATS is an effective and safe procedure that yields a high rate of success at the first attempt and achieves long-term control of malignant pleural effusion due to breast carcinoma. Concomitant biopsies performed during the VATS procedure were a determining factor in the subsequent decision-making process.

In plain English

This study was not about asbestos disease; asbestos appears only because the talc used was described as asbestos-free. The authors, at the European Institute of Oncology in Milan, reviewed the records of 71 women with breast carcinoma and recurrent fluid around the lung (malignant pleural effusion) treated from October 1998 to June 2004. Each had video-assisted chest surgery in which 8 g of asbestos-free sterilized talc was sprayed into the chest to seal the space where fluid collects, and pleural biopsies were taken. There were no operative deaths and no major complications. At one month the procedure had worked in all 71 patients. Eight (11%) later had a recurrence. The overall success rate was 89% (confidence interval 79 to 95%) after a mean follow-up of 22 months. Median survival, measured from surgery, was 17 months. The only factor linked to survival was the number of places the cancer had spread: median survival was 20.5 months when the pleura was the only site, compared with 12.9 months with multiple sites. Biopsy results changed treatment in 18 of 71 (26%) patients. The authors concluded the procedure was safe and effective, with a low rate of recurrence.

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 treated at one center (case series)
• Who was studied: 71 women (mean age 63, range 26 to 78) with recurrent pleural effusion due to breast carcinoma, referred from October 1998 to June 2004 to the European Institute of Oncology, Milan; 76 procedures (5 bilateral)
• Exposure: Not an asbestos exposure study. The treatment studied was video-assisted thoracoscopic (VATS) spraying of 8 g of asbestos-free sterilized talc into the pleural cavity, with pleural biopsies
• Main results:
  • No operative deaths and no intraoperative or postoperative major complications among the 71 patients; 10 of 71 developed a fever without other evidence of infection
  • Median hospital stay was 5 days
  • All 71 patients had effective pleurodesis at 1 month. Eight (11%) had a recurrence.
  • The overall success rate was 89% (confidence interval 79 to 95%) after a mean follow-up of 22 months (range 2 to 81 months)
  • Median survival for the 71 patients was 17 months (range 2 to 80 months), with survival measured from the date of surgery
  • Of the prognostic factors evaluated, only the number of metastatic sites affected survival. Median survival was 20.5 months with the pleura as the only metastatic site versus 12.9 months with multiple sites. The hazard ratio for 3 or more sites versus 1 was 5.49 (95% CI 2.22-13.6), and for 2 sites versus 1 it was 2.35 (95% CI 0.95-5.86)
  • No tumor characteristic was a significant predictor of effusion recurrence
  • Pleural biopsies changed therapy in 18 of 71 (26%) patients. In 7, hormone receptors were found in the pleura although the primary tumor had been receptor-negative. In 7, receptor information was new because records of the primary were unavailable. In 4, c-erbB-2 overexpression was found.
• The authors' conclusion: The authors concluded that chemical pleurodesis via VATS is a safe and effective treatment for pleural effusion, with a low rate of recurrence, and that pleural biopsy was a determining factor in assessing hormone receptor and c-ErbB2 status
• Limitations the authors state:
  • Some tumor characteristics were missing for a few patients in the analyses

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: Pleural Effusion, Carcinoma, Performance Status, Quality of Life, Video-Assisted Thoracoscopic Surgery (VATS), Pleurodesis, Talc, Talc Pleurodesis.

Related studies

• MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial — C. Matthews, C. Freeman, et al. (2019)
• Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients — K. Arapis, R. Caliandro, et al. (2006)
• Tumor type influences the effectiveness of pleurodesis in malignant effusions — S. Bielsa, P. Hernández, et al. (2011)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• GATA-3 and FOXA1 expression is useful to differentiate breast carcinoma from other carcinomas — D.G. Davis, M.T. Siddiqui, et al. (2016)
• Metastasis of cancer to cancer. A case of breast carcinoma metastasizing to a malignant mesothelioma — H.J. Andersen, L.G. Hansen, et al. (1986)

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