PURPOSE: Malignant pleural effusions (MPE) can cause significant dyspnea and poor quality of life. Methods for controlling MPE include thoracoscopy with talc insufflation (TTI) and thoracostomy and talc slurry (TS). An alternative method of providing effective management of symptoms associated with MPE with minimal complication is insertion of a tunneled pleural catheter (TPC). Critics of this procedure suggest it should only be offered to patients not candidates for pleurodesis procedures. Our objective was to examine the effectiveness of TPC in patients with MPE who would otherwise appear to be TTI or TS candidates according to previous studies.
METHODS: Two groups were identified from a large TPC database. Group 1: ≥ 90 day survival and lung re-expansion ≥ 80%; Group 2: ≥ 30 day survival and lung re-expansion of ≥ 90%.
RESULTS: Group 1 criteria was met by 109 of 250 consecutive TPC patients (43.6%) and that Group 2 by 90 (36%). Symptom control at 2 weeks was complete/partial in 67/33% and 69/30% in groups 1 and 2 respectively, with one patient in group 2 experiencing none. Spontaneous pleurodesis was achieved in 70% and 62% of patients respectively, and correlated with symptom control. The median duration of drainage was 85 and 71 days respectively. There was no need for repeat pleural procedures in 95% of those in group 1 and 88% of those in group 2. Few complications and no procedure related deaths were documented.
CONCLUSION: Pleurodesis rates are similar to those achieved with TTI or TS in recent prospective studies. Complications are rare and appear to be less frequent and severe compared to TTI or TS.
CLINICAL IMPLICATIONS: TPC are an effective way of controlling symptoms related to MPE in both the short-term and long-term. TPCs can be considered as first line therapy even in good performance status patients felt to be candidate for TTI or TS.
DISCLOSURE: Alain Tremblay, Consultant fee, speaker bureau, advisory committee, etc. We have received speker’s honorarium from Denver Biomedical Inc. Alain Tremblay & Gaetane Michaud.