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Phase III Intergroup Study of Talc Poudrage vs Talc Slurry Sclerosis for Malignant Pleural Effusion
Open accessAbstract
Study objective To demonstrate the efficacy, safety, and appropriate mode of instillation of talc for sclerosis in treatment of malignant pleural effusions (MPEs).Design A prospective, randomized trial was designed to compare thoracoscopy with talc insufflation (TTI) to thoracostomy and talc slurry (TS) for patients with documented MPE.Measurements The primary end point was 30-day freedom from radiographic MPE recurrence among surviving patients whose lungs initially re-expanded > 90%. Morbidity, mortality, and quality of life were also assessed.Results Of 501 patients registered, those eligible were randomized to TTI (n = 242) or TS (n = 240). Patient demographics and primary malignancies were similar between study arms. Overall, there was no difference between study arms in the percentage of patients with successful 30-day outcomes (TTI, 78%; TS, 71%). However, the subgroup of patients with primary lung or breast cancer had higher success with TTI than with TS (82% vs 67%). Common morbidity included fever, dyspnea, and pain. Treatment-related mortality occurred in nine TTI patients and seven TS patients. Respiratory complications were more common following TTI than TS (14% vs 6%). Respiratory failure was observed in 4% of TS patients and 8% of TTI patients, accounting for five toxic deaths and six toxic deaths, respectively. Quality-of-life measurement demonstrated less fatigue with TTI than TS. Patient ratings of comfort and safety were also higher for TTI, but there were no differences on perceived value or convenience of the procedures.Conclusions Both methods of talc delivery are similar in efficacy; TTI may be better for patients with either a lung or breast primary. The etiology and incidence of respiratory complications from talc need further exploration.
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“thoracoscopic insufflation with talc ( poudrage) is more effective than talc slurry sclerosis [II, B] [145].”
From Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2016) · cites this paper as [145]
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“[27] comparing talc insufflation at a thoracoscopy with the talc slurry, the mortality related to the treatment was reported in 9 of 242 patients in the talc insufflation group and in 7 of 240 patients in the talc slurry group.”
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Lee, H. J., & Feller-Kopman, D. J. (2015) · CHEST Journal · doi:10.1378/chest.15-0424 · Cited by 2
Surgical and Endoscopic Palliation of Advanced Lung Cancer
Cheng, A. M., & Wood, D. E. (2011) · Surgical Oncology Clinics of North America · doi:10.1016/j.soc.2011.07.008 · Cited by 2
Adjunct strategies to enhance the efficacy of indwelling pleural catheters
Gilbert, C. R., & Feller-Kopman, D. J. (2015) · Current Pulmonology Reports · doi:10.1007/s13665-015-0110-z · Cited by 2
Minimally Invasive Techniques for the Diagnosis and Staging of Lung Cancer
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“67% success at 30 days).(58) Some operators prefer to use a semirigid thoracoscope in preference to the rigid scope on the basis that pulmonologists find this system easier to learn as it is close to fiberoptic bronchoscopy in handling.”
BackgroundLight, R. W. (2012) · CHEST Journal · doi:10.1378/chest.12-1088 · Cited by 2
The Role of Thoracic Surgery in Palliative Care: A Review
Klapper, J. A. (2012) · Journal of Palliative Care & Medicine · doi:10.4172/2165-7386.1000133 · Cited by 2
“In sum, the application of talc pleurodesis for the palliation of malignant effusions, while highly effective, should not be dismissed as routine as morbidity and mortality can be significant [21].”
BackgroundTherapeutic Medical Thoracoscopy
Mori, P. A., & Casalini, A. G. (2015) · Monaldi Archives for Chest Disease · doi:10.4081/monaldi.2011.250 · Cited by 2
Management of Malignant Pleural Effusions: Minimally Invasive Techniques
Parmaksız, E. T. (2013) · Solunum · doi:10.5152/solunum.2013.002 · Cited by 2
“Dressler ve arkadaşlarının (27) çalışmasında plöredeze bağlı en sık yan etki ateş olarak bildirilmiştir.”
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Malignant Pleural Effusions: Mistletoe Spray Instead of Talc Poudrage?
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Advanced techniques in local anaesthetic thoracoscopy
Bhatnagar, R., Jones, R. S., & Maskell, N. A. (2017) · European Respiratory Society eBooks · doi:10.1183/2312508x.10004317 · Cited by 2
What happens to the pleural space affected by malignant effusion after bedside pleurodesis?
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“This issue is critical for clinical practice since radiological exams are frequently used to assess the results of pleurodesis and might be misleading.(7) Partial lung expansion and residual pleural space are fairly common and might induce distress to caregivers and patients and,”
BackgroundBudget-impact analysis for pleuroscopy in the diagnosis of undifferentiated pleural effusion
Dhaliwal, I., Gillett, D., Train, E., Amjadi, K., Mitchell, M. A., & Johnson, A. P. (2019) · Canadian Journal of Respiratory Critical Care and Sleep Medicine · doi:10.1080/24745332.2019.1678442 · Cited by 2
Optimal diagnosis and treatment of malignant pleural disease: challenging the guidelines
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Role of imprint cytology in thoracic endoscopy suite
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Malignant Pleural Effusion with Lung Entrapment
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Metadata
- Authors
- Dresler, C. M., Olak, J., Herndon, J. E., Richards, W. G., Scalzetti, E., Fleishman, S. B., Kernstine, K. H., Demmy, T., Jablons, D. M., Kohman, L., Daniel, T. M., Haasler, G. B., & Sugarbaker, D. J.
- Affiliations
- Centre international de recherche sur le cancer (FR)
- Advocate Lutheran General Hospital (US)
- Brigham and Women's Hospital (US)
- SUNY Upstate Medical University (US)
- University of Iowa (US)
- Roswell Park Comprehensive Cancer Center (US)
- University of California, San Francisco (US)
- University of Virginia Health System (US)
- Medical College of Wisconsin (US)
- Corresponding author
- Dresler, Carolyn M
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2005-03
- Volume
- 127
- Issue
- 3
- Pages
- 909-915
- ISSN
- 0012-3692 (ISSN-L)
- PMC
- PMC4644736
- OpenAlex
- W2147481343
- Cited by
- 578
- References
- 39
- Citations by year
- 2026: 10 · 2025: 20 · 2024: 24 · 2023: 12 · 2022: 27 · 2021: 26 · 2020: 40 · 2019: 23 · 2018: 38 · 2017: 31 · 2016: 32 · 2015: 34 · 2014: 32 · 2013: 33 · 2012: 35
- FWCI
- 22.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- CHEST Journal (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (2 U01 CA65170, R01CA093708, U01CA065170)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pleural and Pulmonary Diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Pericarditis and Cardiac Tamponade
- Keywords
- malignant pleural effusion, talc poudrage, talc slurry, talc pleurodesis, thoracostomy, pleural effusion recurrence, respiratory complications, non-relapse mortality, quality of life, lung cancer, breast cancer
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Humans, Insufflation, Male, Middle Aged, Quality of Life, Recurrence, Talc, Thoracoscopy, Thoracostomy, Pleural Effusion, Malignant, Pleurodesis
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