INTRAPLEURAL TALC FOR THE TREATMENT OF MALIGNANT PLEURAL EFFUSIONS SECONDARY TO BREAST-CANCER

Background. The management of malignant pleural effusions secondary to breast cancer is a difficult problem. In the 1980s tetracycline was p robably the most commonly used sclerosing agent, but parenteral tetrac ycline is no longer available. Therefore, it is important to evaluate alternative sclerosing agents. This prospective study was designed to determine the efficacy of insufflated talc in producing pleurodesis in patients with pleural effusions secondary to breast cancer. Methods. Fifty-two patients admitted between May 1985 and November 1992 to the Department of Thoracic Surgery underwent thoracoscopy and had 2 gm ste rile asbestos free talc insufflated throughout the pleural space at th e time of the procedure. One or two chest tubes were inserted and left in place until fluid drainage was less than 100 mi per day. Results. Of the 52 patients, 5 were not evaluable. Two patients died within 30 days of the procedure. In three additional patients the lung did not e xpand after thoracoscopy. The intrapleural insufflation of talc was ef fective in preventing recurrence of pleural effusion. At 30 days there was no recurrence of the pleural fluid in 45 of the 47 (95.7%) patien ts. One of these patients had a recurrence of the effusion 2 months af ter the procedure but the remaining 44 (93.6%) had no recurrence for t he duration of the study. Aerosolized talc was associated with a moder ate morbidity. Six (11.5%) patients had reexpansion edema, but all rec overed. Empyema developed in one patient after the procedure. No episo des of respiratory distress syndrome were observed after talc pleurode sis. Conclusion. The insufflation of 2 gm talc into the pleural space is an effective method to control pleural effusions secondary to breas t cancer.