Affiliations: Southern California Permanente Medical Group Harbor City, CA,
National Cancer Institute of Canada Kingston, ON
Correspondence to: Yossef Aelony, MD, FCCP, Southern California Permanente Medical Group, 25825 Vermont Ave South, Harbor City, CA 90710; e-mail: email@example.com
Parulekar et al (July 2001)1 report an interesting retrospective review of malignant pleural effusions drained with small-bore catheters or large-bore chest tubes. Most of their patients received tetracycline as the sclerosant and not surprisingly showed only a 51 to 53% long-term success rate. Although the success rate is disappointing, it is noteworthy that smaller-bore catheters were as effective as large tubes.
Of perhaps greater importance is their allusion to the use of dry talc insufflation via a large-bore chest tube in a small subset of their series. Talc by thoracoscopic insufflation or by slurry has become the “gold standard” in pleurodesis during the past decade. Any effort to simplify the application of dry talc and thus avoid the need for thoracoscopy is noteworthy. Since there are few data anywhere on this approach, it would be of interest if the authors could provide more information on their talc insufflation subset: (1) of the 27 patients receiving talc, how many received it by insufflation via large tube, (2) what is the 30-day and long-term success rate of these patients, (3) how many milliliters (or grams) of talc were insufflated, and (4) how many days of drainage before and after talc insufflation?
In reply to your questions:
Of the 27 patients receiving talc, how many received it by insufflation via large tube? During the period of interest, all patients who underwent talc installation by large tube also underwent insufflation. Eleven patients were in this group.
What were the 30-day and long-term successes of these patients? Of the 11 patients, 3 patients had recurrence of pleural effusions within a median follow-up period of 5 weeks (range, 3 to 15 weeks). Eight patients had no recurrence at a median of 8 weeks of follow-up (range, 1 to 94 weeks). We saw no difference in the long-term success rates of the large- vs small-bore groups treated with talc (W. Parulekar, MD; unpublished data; June 2002). Seven patients were followed up for at least 30 days; three patients had a recurrence. One of four patients followed up for at least 100 days had a recurrence.
Were patients insufflated with milliliters or grams of talc? This information was not specifically recorded at the time of data retrieval. However, the patients were treated at a tertiary hospital with an active thoracic surgery department; it is a fair assumption that the dose delivered was in keeping with current practice.
Is there a record of the days of drainage before and after talc installation? We measured the duration that the tube remained in place. For this small group of patients, the median duration of tube placement was 7 days (range, 3 to 21 days). Information regarding days of drainage relative to talc installation was not retrieved.
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