Chest
Volume 146, Issue 6, December 2014, Pages e190-e194
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Talc Pleurodesis Through Indwelling Pleural Catheters for Malignant Pleural Effusions: Retrospective Case Series of a Novel Clinical Pathway

https://doi.org/10.1378/chest.14-0394Get rights and content

Abstract

Malignant pleural effusions cause significant morbidity, but there is no gold standard minimally invasive treatment. A new therapeutic approach combines talc pleurodesis and indwelling pleural catheters (IPCs) to enable outpatient management. This case series summarizes the safety and efficacy data of all patients (24) with a symptomatic malignant pleural effusion who underwent talc pleurodeses via IPCs between December 2010 and July 2013. Successful pleurodesis was achieved in 22 procedures (92%). There was one empyema, one hydropneumothorax, one recurrent effusion, and two minor complications: one drain site wound infection and one complaint of chest pain. Twenty-two procedures (92%) were performed in the outpatient setting. This report confirms the safety and efficacy of administering talc slurry through IPCs in an outpatient setting. Studies in a larger cohort are necessary to define the role of this novel approach in the treatment algorithm of patients with this condition.

Section snippets

Study Design

A new treatment protocol was initiated in 2010. To assess outcomes, we performed a retrospective review of procedure documentation, radiology data, and clinic letters. We collected data on the safety, complication rates, and success of talc pleurodesis through an IPC.

Participants

Details of all talc pleurodeses via IPCs between December 2010 and July 2013 were reviewed. We included all procedures on patients with a symptomatic malignant pleural effusion performed by the respiratory department at St. Thomas'

Results

During the study period, 57 IPCs were inserted for patients with malignant pleural effusions. Thirty-three procedures were excluded from the study because there was no subsequent talc pleurodesis through the IPC (reasons included trapped lung and performance status > 1). The remaining 24 procedures fulfilling the study criteria were analyzed.

The baseline patient characteristics are summarized inTable 1. The median age was 70 y (range, 36-83 y), and there was a predominance of women (58%). The

Discussion

This case series of 24 procedures shows that talc pleurodesis via IPC is effective, with successful pleurodesis in 92% of procedures. The procedure is also safe, with a major complication rate of only 12%. Reactions to graded talc were not seen in these patients. There were no IPC blockages following talc slurry instillation. Twenty-two procedures (92%) were performed in the outpatient setting, and no problems resulted from discharging patients home the same day (following talc instillation).

To

Acknowledgments

Financial/nonfinancial disclosures:The authors have reported toCHESTthe following conflicts of interest: Dr Ahmed is a researcher on a study site for the IPC-PLUS trial (ISRCTN73255764). Drs Ip, Rao, and Patel and Ms Noorzad have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributions:CHESTworked with the authors to ensure that the Journal policies on patient consent to report

References (15)

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    Patients drained daily at home until full lung expansion was achieved and then received talc slurry via the TIPC in the outpatient setting followed by continued home drainage. 92% achieved successful pleurodesis [116]. Most recently, the IPC-Plus trial [98] randomized 154 patients with MPE who received TIPC and achieved an acceptable level of lung expansion to talc slurry pleurodesis or placebo via TIPC.

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    Thoracoscopy and tunneled pleural catheters are not mutually exclusive procedures, as both can be performed to achieve pleurodesis and potentially shorten the duration of hospitalization. Pleurodesis can be performed through the catheter with talc slurry, as reported by Ahmed and colleagues.38 After instillation of 4 g of talc in 50 mL of normal saline, patients underwent daily drainage of the effusion.

  • Management of Malignant Pleural Effusion: Where Are We Now?

    2022, Seminars in Respiratory and Critical Care Medicine
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Drs Ahmed and Ip are joint first authors.

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