Complete success rate of pleurodesis was position every 10 to 15 min to allow adequate distribution of talc. The success rate (effective In order to administer talc into the pleural space, we per- cases/evaluable cases) of talc pleurodesis among all patients formed both thoracoscopic talc poudrage and talc slurry at 30, 90 and 180 days was 90.6% (48/53), 80.9% (38/47) through a Sorted by: Results 1 - 10 of 10. Chest ultrasound prior to pleurodesis showed a sensitivity of 91% and a specificity of 88% in predicting the success of pleurodesis. In addition, thoracoscopic talc poudrage was more effective than bedside talc slurry (relative risk, 1.12; 95% confidence interval, 1.01-1.23; p = 0.026). Talc pleurodesis is a specific form of chemical pleurodesis. The predominant cause of pleurodesis with talc slurry instillation is an acute pleural injury similar to the tetracycline class agents. Pleurodesis by mechanical and chemical pleural irritation has been extensively studied during the past century. Tetracycline, The effect of common sclerosing agents on the rabbit pleural space. Ex - cluding one patient who died in the rst month, the success The procedure is performed using video-assisted thoracoscopy (keyhole surgery). An RCT of 18 centers reported that the administration of talc through an IPC achieved higher rates of pleurodesis than an IPC alone (43% vs. 23%, P = 0.0008) as of day 35, and the talc group still had superior pleurodesis rates (51% vs. 27%, P = 0.003) on day 70 . About talc pleurodesis: poudrage and slurry are both recommended Kolschmann et al. Videothoracoscopic talc poudrage achieves a high success rate in the treatment of primary spontaneous pneumothorax with a very low morbidity rate. 1.Thoracoscopic (VATS) talc pleurodesis. We instilled 70 mg/kg of sterile asbestos-free talc slurry into the pleural space of New Zealand white rabbits and studied the inflammatory response at 1, 2, 3, 7, 15, 30, 60, 90, and METHODS:All symptomatic patients with malignant pleurisy subjected to talc pleurodesis through medical thoracoscopy between January 2012 and December 2015 were included. Medical thoracoscopic talc pleurodesis has been safe and effective in the treatment of some other varieties of recurrent pleural effusions. Although talc slurry pleurodesis is effective for control of malignant pleural effusions and recurrent pneumothorax, the mechanisms of pleurodesis remain incompletely defined. When compared with talc, iodopovidone produces similar results, with a low side effect profile and less pain. Primary end-points will be pleurodesis success. All 105 patients in our study underwent talc pleurodesis (slurry or poudrage); unfortunately success rates of this treatment were available for only 84 (80%) of them. Cancer (1995) by M Petrou, D Kaplan Add To MetaCart. The 30-day mortality rate was 16.7% (n = 17). , , , The success rate in preventing recurrence of fluid accumulation is high (85 to 98%), , , thus alleviating dyspnea in these patients. Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience. Results: A total Talc pleurodesis is a common treatment modality for palliation of patients with malignant pleural effusion. In the talc group, pleurodesis was a total success in 11 (52%) patients and partial in 6 (29%) patients. 13,14 Talc pleurodesis can be made by talc slurry via tube thoracostomy or talc insufflation via thoracoscopy. Of these cases, talc was used in 65% with a success rate of nearly 100%. Special efforts must focus on reducing the overall time spent in the hospital. described no significant influence on thoracoscopic talc poudrage success rate due to the primary neoplasm type, but life expectancy resulted shorter in patients with lung cancer (cumulative survival rate: 29%) than other malignancies . This success rate is significantly better than the thoracostomy outcome (p = 0.016). Excluding 8 patients who died in the rst month, the success rate increased to 93% (38/41). Conclusions. Patients with successful talc pleurodesis had a median forced vital capacity (FVC) of 102% and median total lung capacity of 99% at follow-up. Tools. Conclusions: The current The secondary end-points are hospital length-of-stay, complication rates, analgesia requirements, pain scores and quality-of-life scores. Recurrences show a statistically significant relationship (P:.037) with smoking habits. When it is successful, this procedure can save the patient from having to undergo further invasive chest and lung surgeries to drain a buildup of fluids. Various meta-analyses confirmed that talc is superior to other agents for performing pleurodesis., Talc used for chemical pleurodesis should be sterile (Steritalc) and graded (<10% of the talc particles should be <10 in diameter). 5%: 4%: 64%: 1d: Aelony et al: 42: 93%: 2.7: 92%: 92%: 0: 0 (1.9d) Other sclerosing agents, such as bleomycin, silver nitrate, and povidone-iodine, have also been used, however very rarely. The mean length of hospital stay for the thoracoscopy group was 4.6 3.3 days (range, 113 days). There are two methods of talc pleurodesis. The tetracycline derivative doxycycline is an alternative sclerosant with reported success rates of about 80 percent. Pleurodesis failed if pleural effusion accumulated after pleurodesis, and success was measured according to the longest pleural effusion-free period. Pleurodesis success rates were as follow: 17.7% had complete success, 12.9% had partial success, 40.3% had failed pleurodesis, 3.2% died shortly after pleurodesis, and 25.8% were lost to follow-up. Talc (3 MgO, 4SiO 2, and H 2 O) is considered to be one of the most successful sclerosing agents for pleurodesis, whether it is insufflated into the pleural space via thoracoscopy or is administered in the form of talc slurry, when compared to doxycycline, tetracycline, and bleomycin. Although studies have shown talc to be the best chemical agent in terms of pleurodesis success and risk of recurrence 21, 22, the best method of applying talc remains controversial. Talc Pleurodesis in Pleural Disease PLEURA Volume 6, 2019 7 Review Talc Pleurodesis in Pleural Disease Mathieu Marcoux, MD1 pleurodesis rates with talc in MPE has been re-ported in up to 93 % of cases27. Talc pleurodesis gives a success rate of 81 to 100%, which is in contrast to 65 to 76% achieved with tetracycline and its derivatives and 61% for bleomycin. Results: The success rate o f talc slurr y pleurodesis was 7 8% (38/49). The statistical significance of the RR was determined by the use of the Z test. Talc pleurodesis was first performed in 1935 20 and is still commonly employed in the treatment of malignant pleural effusions. Furthermore, reports 5, 7, 11, 12 on ARDS following talc pleurodesis have raised concerns about the safety of talc in the last few years. CONCLUSION: The success rate of pleurodesis in malignant pleurisy could potentially be enhanced by correct patient selection and early referral for pleurodesis. Thoracoscopic pleurodesis was successful in 77% (17/22) of patients. The significance was set at P < 0.05. Conclusions: Chemical pleurodesis, and specifically talc slurry, is an effective treatment for recurrent benign or undiagnosed pleural effusion. Talc pleurodesis: comparison of talc slurry instillation with thoracoscopic talc insufflation for malignant pleural effusions Pleurodesis with instillation of talc slurry and with insufflation of talc during thoracoscopy were equally successful in patients with massive malignant pleural effusions. Talc pleurodesis is successful in about 70 percent to 80 percent of cases. Of these cases, talc was used in 65% with a success rate of nearly 100%. The primary endpoint was the success rate of pleurodesis, and the secondary endpoint was the complication rate (pain and fever). A review of talc pleurodesis studies, published in 1994 , found identical success rates of 91% for poudrage (n = 461) and slurry (n = 166). Methods: A retrospective review of patients undergoing talc pleurodesis at our institution between The success rate of thoracoscopic talc pleurodesis was 91% (29 of 32), with the three failures secondary to trapped lung that required continuous drainage. Although talc slurry pleurodesis is effective for control of malignant pleural effusions and recurrent pneumothorax, the mechanisms of pleurodesis remain incompletely defined. 2018;23(6):613. Previously, the success rate of talc pleurodesis has been reported to be over 90% in selected patients (19-21). The lung being operated on is collapsed by the anaesthetist to allow the surgeon access to the lung and the pleural cavity (the body compartment where the lung is located). The success rate did not show any statistically significant difference between patients who underwent postoperative adjuvant therapy and patients who did not. AU Leemans J, Dooms C, Ninane V, Yserbyt J SO Respirology. The identification of clinical and endoscopic features that determine the success of talc pleurodesis in malignant pleurisy could guide clinical decision-making. Talc pleurodesis at 48 g in lymphoma-related chylothorax showed a 100% success rate in a small case series . Talc slurry (talc mixed with normal saline 5 g talc: 50100 mL sterile normal saline), instilled via an intercostal catheter, is a useful technique for achieving pleurodesis in patients not fit for or declining surgical intervention. Yim and colleagues , in a small randomized trial, also demonstrated no difference between the two techniques. Patients with successful talc pleurodesis had a median forced vital capacity (FVC) of 102% and median total lung capacity of 99% at follow-up. BACKGROUND AND OBJECTIVE Malignant pleurisy is associated with advanced oncological disease and dyspnoea is the most common presenting Methods Data of 113 effusions in 103 MPE patients treated between 1999 and 2007 were retrospectively evaluated for the study. Conclusions. A recent review of 1200 procedures of talc pleurodesis reiterates the excellent success rates when talc is administered by slurry (87%) or by talc poudrage (93%) in the treatment of pneumothorax (91%) and pleural effusion (91%). In Egypt, however, the use of talc powder has been disapproved and it remains unavailable in the Egyptian market . Conclusion The success rate of pleurodesis in malignant pleurisy could potentially be enhanced by correct patient selection and More recently, the largest series of VATS treated PSP using primarily talc pleurodesis was reported . Statistical analysis by Chi square was used. Although talc slurry pleurodesis is effective for control of malignant pleural effusions and recurrent pneumothorax, the mechanisms of pleurodesis remain incompletely defined. Excellent long-term results of pleurodesis have been reported after using talc success rate of 82.192.7 [1, 4, 5]. The British Thoracic Society guideline 3 advocates use of smaller tubes and cites an overall success rate for talc pleurodesis of 60% to 90%, with 7 of 15 studies cited using large (20-28 French [F]) tubes. The success rates of pleurodesis between the talc and laser groups showed no significant difference (p=0.725). The 30-day mortality rate was 16.7% (n = 17). Results: Overall, TP demonstrated greater success rate at 1 month compared to TS (85% vs 68% p=0.01) with no difference at 3 months (77% vs 88% p=0.21). Introduction To determine the factors affecting the success of bedside talc slurry (TS) used for symptomatic treatment of patients with malignant pleural effusion (MPE). The comparison of pleurodesis success rates between talc and control groups was done by calculating the 95% confidence interval (95% CI) and the pooled risk ratios (RR), using a MantelHaenszel method. Type of primary neoplasm had no significant influence on success rate. 82% of patients had successful pleurodesis with poudrage versus 67% success with slurry. Success, 30 d Success, Death/1 Yr Empyema Respiratory Failure; Kennedy et al: 75: Less than: 7.1 : 81%? Video-Thoracoscopic Surgical Pleurodesis in the Management of Malignant Pleural Effusion: The Importance of an Early Intervention By Antonio Marrazzo SERIES ''INTERVENTIONAL PULMONOLOGY'' Edited by J.P. Janssen, M. Noppen and K.F. It is low cost, and available. Shouman et al. What are the long term effects of pleurodesis? Its success rate is excellent, and talc is generally well tolerated. 12. Success is defined as fully expanded lung at the end of the procedure and no recurrence of the effusion at long-term follow up, according to the study. In the same survey, talc (both poudrage or slurry) talc pleurodesis requires intensive treatment and it is associated with a high mortality rate. Pleurodesis with instillation of talc slurry and with insufflation of talc during thoracoscopy were equally successful in patients with massive malignant pleural effusions. However, thoracoscopic pleurodesis is accompanied with considerably more complications, rather as a result of the thoracoscopy Based on power calculations, we aim to recruit 120 patients in each arm. demonstrated that tetracycline, talc slurry, iodopovidone, and bleomycin, all resulted in comparable success rates of 80%, 80%, 66.6%, and 73.3% at 30 days. Recurrences show a statistically significant relationship (P:.037) with smoking habits. In addition, thoracoscopic talc poudrage was more effective than bedside talc slurry Relief of dyspnoea and improvement in quality of life can be achieved with either talc pleurodesis or insertion of an indwelling tunneled pleural catheter (IPC). Talc is the most effective sclerosant available for pleurodesis in malignant pleural effusion . reported that the 30-day success rate of talc was 71%, and Yoshida et al. At the end of the primary observation period of 180 days, 38 of 46 surviving patients (82.6%) had a successful pleurodesis. The success rate for talc pleurodesis is around 90%. This procedure is safe and easily performed and, in selected cases, can be performed in an outpatient day-care setting. The complications, length of hospital stay, and success rate over a 24-month period were studied. The identification of clinical and endoscopic features that determine the success of talc pleurodesis in malignant pleurisy could guide clinical decision-making. The assessing time of success rate of talc pleurodesis in the. The success rate of a talc pleurodesis has been reported to be greater than 75%. The most common side effect was chest pain. Most patients, however, die within several months because of their underlying disease. A three-fold increase in failure rate after slurry in a small study was not statistically significant. There is less evidence to support its use in non-malignant effusions like chylothorax. Clive et al. The success rate of talc pleurodesis was significantly higher than that of control therapies (relative risk, 1.21; 95% confidence interval, 1.01-1.45; p = 0.035) with similar adverse events. 2,3 I have carefully reexamined the data from our review of complete success for malignant pleural effusions and found that talc had a success rate of 90.2% (147 of 163 pleurodeses), as Respirology 2018; 23:613. Excluding 8 patients who died in the first month, the success rate increased to 93% (38/41). Patients who receive talc powder pleurodesis at thoracoscopy were not included. 13, 14 Talc pleurodesis can be made by talc slurry via tube thoracostomy or The study group involved 73 patients whose follow-up information was In hospital mortality was 2% and the pleurodesis success rate was 85%. A poor Karnofsky Performance Status and delay between diagnosis of pleural effusion and pleurodesis were statistically significant factors for in-hospital mortality. P Dresler et al. Type of primary neoplasm had no significant influence on success rate. The success rate of talc pleurodesis was significantly higher than that of control therapies (relative risk, 1.21; 95% confidence interval, 1.011.45; p=0.035) with similar adverse events. Clementsen et al. Instead, bleomycin, which is expensive and less effective, is being used. We used 4 g of talc, with no reduction in the success rate and no cases of respiratory insufficiency attributable to the procedure. studied the effect of route size, either chest tube or small catheter, on the results of pleurodesis success and recurrence of effusion. Thoracic MPE included lung cancer and mesothelioma. One meta-analysis of 13 observational studies with 499 patients found that iodopovidone was safe with success rate of pleurodesis was 70-100%. was associated to a higher success rate compared with other agents4. 2. The success rate of talc slurry pleurodesis was 78%(38/49). Complications, Side Effects, and Recovery 8 The superiority of talc over other agents is Long-term success was observed in 53 (95%) out of 56 patients. Of these cases, talc was used in 65% with a success rate of nearly 100%.
Chemical pleurodesis, and specifically talc slurry, is an effective treatment for recurrent benign or undiagnosed pleural effusion. This kind of invasive treatment may by itself cause some morbidity and mortality. It involves achieving an area of adhesion between the parietal and visceral layers of the pleura. This has been demonstrated by the lower than expected pleurodesis success rate in a recent study in which patients were only drained after talc pleurodesis intermittently (23 times a week) via their indwelling pleural catheter. Success was defined as absence of a repeat pleural procedure and/or fluid re-occupying <1/3 of the hemi-thorax. However, TP success rate in an intention-to-treat analysis (ITT) is low. Talc pleurodesis is usually performed in general anaesthesia and requires postoperative drainage and hospitalisation. Recurrence rate was 15% [95% CI: 7, 26] in a median follow-up duration of approximately 18.3 months [95% CI: 10.5, 26.0]. Hartman DL. The overall rate of success was 50%, for lung primary 75%, breast 33%, gynaecological 33%, other 44%. ssive alternative interventions like thoracoscopic talc pleurodesis (TTP) should be evaluated. Thoracoscopic pleurodesis was successful in 77% (17/22) of patients. Goldstraw P. Management of recurrent malignant pleural effusions: the complementary role of talc pleurodesis and pleuroperitoneal shunting. Results: The success rate of talc slurry pleurodesis was 78%(38/49). Thoracoscopic pleurodesis was success ful in 77% (17/22) o patients. The procedure is performed under general anaesthetic. Methods: Data were extracted on patients who had undergone TTP for complicated spontaneous pneumothorax at Interventional Clinic, University Hospital, Brussels, Belgium. Radiographic features CT. After talc pleurodesis, the pleural In small studies, pleurodesis had success rates of around 75-80 percent in people with pleural effusion not caused by cancer. The overall pleurodesis success rate at 30 days was 82.0% in the ABP group, comparable to the talc pleurodesis group (87.0%, p = 0.12).
Two randomized studies (15, 16) comparing the efficacy of talc slurry and bleomycin were unable to demonstrate any significant difference in the success rates with the two agents. Pleurodesis is well validated in malignant pleural effusion with reported success rate up to 76% . Talc pleurodesis gives a success rate of 81 to 100%, which is in contrast to 65 to 76% achieved with tetracycline and its derivatives and 61% for bleomycin. included studies varied from 1 m to several months or until death, we therefore evaluated the short-term (1 m) and long-term (longer. Last medically reviewed on March 23, 2018 10 sources collapsed PDF | Introduction: Pleurodesis fails in 10-40% of patients with recurrent malignant pleural effusions MPEs and dyspnea. Median survival after talc insufflation was 7.8 months [95% CI: 6.4, 9.2]. Pleurodesis success rate was 86% [95% CI: 82, 91]. Instead, bleomycin, which is expensive and less effective, is being used. Chemical pleurodesis, and specifically talc slurry, is an effective treatment for recurrent benign or undiagnosed pleural effusion. Background: Sterile talc is currently the agent of choice for pleurodesis. The talc dosage for pleurodesis usually ranges between 2 and 14 g. Some authors attribute cases of respiratory failure following talc pleurodesis to doses higher than 7 g . Talc is not water-soluble, and it must be suspended in saline (talc slurry) for administration. No studies of talc slurry pleurodesis for SP alone were found, except two studies with small comparator groups of 14 and 10 patients, which gave 21.4% and 0.0% recurrence rates, respectively. In Egypt, however, the use of talc powder has been disapproved and it remains unavailable in the Egyptian market . Videothoracoscopic talc poudrage achieves a high success rate in the treatment of primary spontaneous pneumothorax with a very low morbidity rate. Many reports showed talc pleurodesis as the surgical pleurodesis of choice for recurrent malignant effusion, with a reported success rate of 90% [8,9]. 74. A study published on UpToDate cited a study showing that talc pleurodesis has at least a 90% success rate. METHODS:All symptomatic patients with malignant pleurisy subjected to talc pleurodesis through medical thoracoscopy between January 2012 and December 2015 were included. a review of the english literature from 1966 to 1994 of 1,168 patients treated with chemical agents for malignant pleural effusions showed that talc was clearly the most effective, with a complete success rate of 93%, compared with corynebacterium parvum (76%, no longer available), tetracycline (67%, no longer available), doxycycline (72%, Chest ultrasound prior to pleurodesis showed a sensitivity of 91% and a specificity of 88% in predicting the success of pleurodesis. Both studies concluded that in the long-term talc pleurodesis did not produce significant adverse effects on lung function. The difference in success rates can be ex-plained by the effectiveness of the various pleurodesis agents used, patient selection, procedural technique, dosage, and var-ious success criteria. Talc pleurodesis (TP) is the current standard treatment when MPE recurs and patients life expectancy is at least 3 months . Leemans J, Dooms C, Ninane V, Yserbyt J. Two randomized studies (15, 16) comparing the efficacy of talc slurry and bleomycin were unable to demonstrate any significant difference in the success rates with the two agents. reported that the 4-week pleural progression-free survival rate of OK-432 was 75.8%. Of these cases, talc was used in 65% with a success rate of nearly 100%. Excluding 8 patients who died in the first month, the success rate increased to 93% (38/41). Efficacy of Talc Pleurodesis. In the present study, the success rate of pleurodesis with talc slurry through a smallbore chest tube was found to be 81% (17 of 21 cases; complete success in 11 patients and partial success in 6 patients). Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience. However, concerns remain about the safety of talc. The recurrence rate of MPE depends on tumor type, and MPE recurs earlier after drainage of larger volumes . Many reports showed talc pleurodesis as the surgical pleurodesis of choice for recurrent malignant effusion, with a reported success rate of 90% [8,9]. Talc is the most commonly used and the most effective sclerosant available for pleurodesis. After a median follow-up of 64 months (range 5105 months), talc pleurodesis was successful in controlling recurrence of effusion in 92.7% (558 out of 602) of patients. The success rate of talc pleurodesis for partial and complete response has been reported in most studies as 63-93% [3,15,16]. The data support consideration of standard use of thoracic ultrasonography in patients undergoing MPE-related However, a recent experience with fulminant pneumonitis following talc pleurodesis prompted a review of our experience. Recurrent pneumothorax was observed in three (5%) out of 56 patients. Thoracic ultrasonography-guided care for pleurodesis in patients with MPE results in shorter hospital stay (compared with the British Thoracic Society recommendation for pleurodesis) without reducing the success rate of the procedure at 3 months. At the end of the primary observation period of 180 days, 38 of 46 surviving patients (82.6%) had a successful pleurodesis. Results: A total of 42 TP were included. A dose of 4-5g of sterile asbestos-free talc, which has been associated with the highest success rates, can be used for pleurodesis. Our pleurodesis success rates of 71.1 and 78.8% at 3 and 6-months compare well with TAPPS, and are higher than in trials utilizing IPCs. In small studies, pleurodesis had success rates of around 75-80 percent in people with pleural effusion not caused by cancer. 55, 56 A meta-analysis showed success rates of iodopovidone as high as 89% to 95% in MPE and PSP, with pain and hypotension as the most notable side effects. The trial is aimed to be completed within 3 years. The former requires a lengthy hospital stay and the latter is associated with lower pleurodesis rates. 1520. Tiong TY, Tam KW. Conclusions: Chemical pleurodesis, and specifically talc slurry, is an effective treatment for recurrent benign or undiagnosed pleural effusion. Conclusion:The use of Ho-YAG laser through VATS is a safe and effective option for pleurodesis in the management of MPE. A 2013 Australian review of pleurodesis for mesothelioma patients confirmed talc pleurodesis as the most effective treatment, and a 2016 Cochrane review also found talc pleurodesis the most effective for malignant pleural effusions. Consideration regarding the source and calibration of talc particles may be important. month after pleurodesis . While promising in this study, talc slurry has a long way to go before matching the published success rates, low morbidity, and shorter chest tube drainage already shown throughout the world in TTP, under local or waking anesthesia. Amjadi K, Forster A, Aaron S (2013) Management of malignant pleural effusions with indwelling pleural catheters or talc pleurodesis. Furthermore, 86.7% of patients were safely discharged on the same day, reducing reliance on hospital bed capacity which may be severely limited in situations such as the coronavirus pandemic. Talc pleurodesis is one of the chemical methods of pleurodesis which is a procedure performed to prevent recurrence of a pneumothorax or recurrent pleural effusion in benign or malignant conditions.