Original Article

Comparison of the efficacy Talc solution injection through Chest Tube and Talcum Powder through Pleuroscopy for the Treatment of Malignant Pleural Effusion: a randomized clinical trial

Abstract

Background: The aim of the present study was to compare the different outcomes and response rates of talc
powder injection via chest tube and talc spray through thoracoscopy in the treatment of malignant pleural effusion in patients.
Methods: In this randomized controlled trial, patients with malignant pleural effusion, who were hospitalized
in the surgery and hematology-oncology departments of Shariati and Imam Khomeini Hospitals, were enrolled.
The patients were randomly divided into two groups: chest tube and pleuroscopy, using simple randomization.
The mean and standard deviation, frequency and percentage, independent sample t-tests, chi-square, and Fisher’s
exact tests were used for data analysis. A p-value of less than 0.05 was considered statistically significant.
Results: No significant difference was observed between the two groups in the incidences of chest pain, fever,
and both symptoms (p > 0.05). The treatment success rates among the chest tube and pleuroscopy cases were
83.3% and 100%, respectively, and there was no significant difference between the two groups (p = 0.05). Among the five patients who had a recurrence, four (80%) had lung cancer, and one (20%) had liver cancer, and this difference was significant (P = 0.003). Regarding the rate of response to the treatment according to the side witheffusion, among the people who had a relapse, two people (40%) had right-sided effusion, and three others (60%) had left-sided effusion (P = 0.623).
Conclusions: Both techniques were safe, had minor side effects, were transient, and easy to manage. However,
the recurrence of the disease in the thoracoscopic pleurodesis method was significantly less than in the chest tube.

1. Najmunnisa N, Mohammed KA, Brown S, Su Y, Sriram P, Moudgil B, et al. Talc mediates angiostasis in malignant pleural effusions via endostatin induction. Eur Respir J. 2007;29(4):761-9. https://doi. org/10.1183/09031936.00061606
2. Kilic D, Akay H, Kavukçu Ş, Kutlay H, Cangir AK, Enön S, et al. Management of recurrent malignant pleural effusion with chemical pleurodesis. Surg Today.2005;35(8):634-8. https://doi.org/10.1007/s00595-005- 2996-5
3. Terra RM, Teixeira LR, Bibas BJ, Pego-Fernandes PM, Vargas FS, Jatene FB. Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status. Clinics (Sao Paulo). 2011;66(2):211-6. https://doi. org/10.1590/S1807-59322011000200005
4. Bizhani K, Eissazadeh M. Clinical characteristics, etiology, and diagnostic evaluation of exudative pleurisy in Babol (1996-2002).
5. Kolschmann S, Ballin A, Gillissen A. Clinical efficacy and safety of thoracoscopic talc pleurodesis in malignant pleural effusions. Chest. 2005;128(3):1431- 5. https://doi.org/10.1378/chest.128.3.1431
6. Cardillo G, Facciolo F, Carbone L, Regal M, Corzani F, Ricci A, et al. Long-term follow-up of video-assisted talc pleurodesis in malignant recurrent pleural effusions. Eur J Cardiothorac Surg. 2002;21(2):302-6. https://doi. org/10.1016/S1010-7940(01)01130-7
7. Ferrer J, Montes JF, Villarino MA, Light RW, Garcìa- Valero J. Influence of particle size on extrapleural talc dissemination after talc slurry pleurodesis. Chest. 2002;122(3):1018-27. https://doi.org/10.1378/ chest.122.3.1018
8. Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and management. Open Access Emerg Med. 2012;4:31-52. https://doi.org/10.2147/OAEM.S29942
9. Maskell NA, Lee YG, Gleeson FV, Hedley EL, Pengelly G, Davies RJ. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004;170(4):377-82. https://doi.org/10.1164/rccm.200311-1579OC
10. Mierzejewski M, Korczynski P, Krenke R, Janssen JP. Chemical pleurodesis-a review of mechanisms involved in pleural space obliteration. Respir Res. 2019;20(1):16. https://doi.org/10.1186/s12931-019- 1204-x
11. Rehse DH, Aye RW, Florence MG. Respiratory failure following talc pleurodesis. Am J Surg. 1999;177(5):437- 40. https://doi.org/10.1016/S0002-9610(99)00075-6
12. Yoon DW, Cho JH, Choi YS, Kim J, Kim HK, Zo JI, et al. Predictors of survival in patients who underwent videoassisted
thoracic surgery talc pleurodesis for malignant pleural effusion. Thorac Cancer. 2016;7(4):393-8. https://doi.org/10.1111/1759-7714.12354
13. Viallat JR, Rey F, Astoul P, Boutin C. Thoracoscopic talc poudrage pleurodesis for malignant effusions: a review of 360 cases. Chest. 1996;110(6):1387-93.
https://doi.org/10.1378/chest.110.6.1387
14. Viallat J, Boutin C. Malignant pleural effusions: recourse to early use of talc. Rev Med Interne. 1998;19(11):811-8. https://doi.org/10.1016/S0248-8663(98)80385-8
15. Hunt BM, Farivar AS, Vallières E, Louie BE, Aye RW, Flores EE, et al. Thoracoscopic talc versus tunneled pleural catheters for palliation of malignant pleural effusions. Ann Thorac Surg. 2012;94(4):1053-9. https:// oi.org/10.1016 j.athoracsur.2012.01.103
16. Stanton SE, Disis ML. Clinical significance of tumorinfiltrating lymphocytes in breast cancer. J Immunother Cancer. 2016;4(1):59. https://doi.org/10.1186/s40425- 016-0165-6
17. Mahvi DA, Liu R, Grinstaff MW, Colson YL, Raut CP. Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies. CA Cancer J Clin. 2018;68(6):488-505. https://doi.org/10.3322/ caac.21498
18. Haiati F, Hajyani E, Tavakoli H, Eideni E, Borsi SH, Shahbaziyan H, et al. Causes of pleural effusion in long-term hemodialysis. Sci Med J. 2010;8(4).
19. Naghshvar F, Torabizadeh Z, Ghaemian A, Emadian O, Gahremani M. The diagnostic value of cholesterol in the differentiation of exudative and transudative pleural effusion. J Mazandaran Univ Med Sci. 2007;16(56):37-43.
20. Safavi E, Ensani F, Arian A, Ebrahimi M, FirouzbakhshS. The Comparison of The Results of Cytologic Examination Pleural Fluid and Needle Biopsy in Malignant Pleural Effusions. [No further information available]
21. Reddy C, Ernst A, Lamb C, Feller-Kopman D. Rapid pleurodesis for malignant pleural effusions: a pilot study. Chest. 2011;139(6):1419-23. https://doi. org/10.1378/chest.10-1868
22. Mitrofan C, Aldea A, Grigorescu C, Jitaru I, Iosep G, Aramā A, et al. Thoracoscopic pleurodesis in malignant pleural effusions. Rev Med Chir Soc Med Nat Iasi. 2005;109(4):799-803.
23. Sahn SA. Is Talc Indicated for Pleurodesis?: Pro: Talc Should Be Used for Pleurodesis. J Bronchology Interv Pulmonol. 2002;9(3):223-7. https://doi. org/10.1097/00128594-200207000-00013
Files
IssueVol 6 No 1 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ajs.v6i1.14712
Keywords
Chest Tube Talcum Powder Pleuroscopy Malignant Pleural Effusion
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Taghizade N, Ershadi R, Yaghoobi Notash A, Molavi B, Ghorbani Abdgah A, Najafi Kandovan M. Comparison of the efficacy Talc solution injection through Chest Tube and Talcum Powder through Pleuroscopy for the Treatment of Malignant Pleural Effusion: a randomized clinical trial. AJS. 2023;6(1):11-16.