Objective: The aim of this study was to investigate the effectiveness, safety and appropriate mode of administration of intrapleural talc for pleurodesis, in the treatment of malignant pleural effusion (MPE).
Methods: Prospective study was conducted to compare thoracoscopic talc poudrage (TP) with tube thoracostomy and talc slurry (TS) for the local control of malignant pleural effusion. From November 2002 to May 2008, 85 consecutive patients were involved in the study for either video-assisted thoracoscopic talc poudrage (TP) under general anesthesia (n = 35) or talc slurry (TS) by the bedside (n = 50). Patients with poor general condition (Karnofsky score less than 60%) or trapped lungs were excluded from this study. Five grams of purified talc was used for either procedure.
Results: Thirty-three patients in the TP group (94.2%) and 47 in the TS group (94%) had 1q2successful pleurodesis (P = 0.9702) 30 days after the procedure; 32 patients (91.4%) and 44 patients (88%) had a successful pleurodesis (P =0.6257) 90 days after the procedure; 28 patients (80%) and 37 patients (74%), respectively, had a life-long pleural symphysis (P = 0.3890). Adverse effects were generally mild: chest pain (22.8% in TP patients, 20% in TS patients) and fever (34.2% and 30%, respectively) were the more common but the difference was not significant between the two groups. We observed neither acute respiratory failure nor mortality due to the procedure.
Conclusions: Video-assisted thoracoscopic talc poudrage has not been shown to be a superior approach compared with talc slurry in our study. Because the former demands more resources, we advocate that talc slurry should be considered as the procedure of choice in the treatment of symptomatic malignant pleural effusion in patients who do not have trapped lungs.