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Rebuttal From Dr LeeRebuttal From Dr Lee

Pyng Lee, MD, FCCP
Author and Funding Information

From the Division of Respiratory and Critical Care Medicine, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore.

Correspondence to: Pyng Lee, MD, FCCP, Division of Respiratory and Critical Care Medicine, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Rd, Singapore 119228; e-mail: pyng_lee@nuhs.edu.sg

Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):19-20. doi:10.1378/chest.12-1086
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Malignant pleural effusions (MPEs) treated with simple aspiration and intercostal tube drainage without instillation of a sclerosant are associated with high rates of recurrence. According to a survey of >800 physicians who collectively performed >8,000 pleurodesis, thoracoscopic talc poudrage (TTP) was preferred over tube talc slurry (TS).1 Cochrane database and systematic reviews have also shown better outcome with TTP than tube TS.2,3 Although overall success rates in the phase III intergroup study comparing TTP and tube TS were similar, TTP provided more comfort and safety and was more effective than slurry for breast and lung cancers, which account for 50% to 65% of MPEs.4 Moreover, Aelony and Yao5 have demonstrated better survival after talc poudrage for mesothelioma, and 90% of patients with mesothelioma will develop symptomatic MPEs during the course of disease.6 The phase III intergroup study4 excluded patients with trapped lungs because of extensive intrapleural tumor load and pleural loculations, which occur in up to 30% of MPEs and are the main cause for pleurodesis failure. Thoracoscopy facilitates lysis of adhesions, which promotes drainage of pleural loculations to allow the underlying lungs to expand and enhances success of pleurodesis.7

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