The value of small-bore catheter thoracostomy in the treatment of malignant pleural effusions

Background. Malignant pleural effusions can cause severe debilitating sympt oms and impair the quality of life. Treatment is often palliative, usually consisting of sequential thoracenteses or tube thoracostomy with or without sclerotherapy. Large-bore thoracostomy tubes have traditionally been used for drainage and sclerotherapy. More recently, the use of small-bore cathet ers has been studied. Objectives. To assess the efficacy and safety of smal l-bore catheter (Pleuracan (R)) thoracostomy combined with talc sclerothera py for palliative treatment of malignant pleural effusions. Methods: Betwee n May 1998 and March 2000, 24 consecutive patients presenting at our inpati ent clinic were studied. Follow-up radiography at the end of the 1st month (immediate response) and 3rd month (long-term follow-up) after talc pleurod esis was performed to assess the response rates. Results: Of the 24 patient s included, 2 patients did not show lung expansion after pleural drainage. Two patients died within 30 days after talc pleurodesis and 1 did not under go 30-day postpleurodesis radiography. The remaining 19 patients made up th e study group to assess the response rates (8 men, 11 women). Overall respo nse rates of talc pleurodesis via small-bore catheter were found to be 84.2 % [complete response (CR): 68.4%, partial response (PR): 15.8%] at 30-day a nd 78.6% (CR: 57.2%, PR:2 1.4%) at 90-day follow-up, respectively, One pati ent reported moderate pain during catheter placement. Four patients experie nced mild to moderate pleuritic chest pain, shortness of breath, or both wi thin 4 h after instillation. Seven of the 22 patients (31.8%) had a transie nt fever (less than or equal to 39.0 degreesC) 6-24 h after talc instillati on that lasted less than 24 h and was successfully treated with acetaminoph en. One patient had significant subcutaneous emphysema that resolved in 2,4 h. Four patients died because of tumor progress (2 patients in the 1st mon th and 2 patients between 30 and 90 days). Conclusion: Pleurodesis can succ essfully be performed via a small-bore catheter in patients with recurrent malignant pleural effusion. To validate the results of the study, a prospec tive randomized study, comparing this device (Pleuracan) and a 'standard' 1 6- to 24-french chest drain, should be performed. Copyright (C) 2001 S. Kar ger AG, Basel.