Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11026

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    P1.24-025 - Palliation of Malignant Pleural Effusion by Pleurodesis a comparative study (ID 1845)

    09:30 - 09:30  |  Author(s): A. El Bastawisy
    • Abstract

    Background
    Sever dyspnea secondary to persistent or recurrent malignant pleural effusion in terminally ill cancer patients offers great challenge to the treating physicians. It has a significant negative impact on the quality of life which is already poor. The main goal of treating physician is symptomatic relief of dyspnea with the least possible tools. A variety of agents can be used to induce pleurodesis. Multiplicity of those agents indicates that none of them is optimal. Whatever the agent used, it should achieve high success rate with no or minimal side effects and tolerability by the patient. Great care should be taken to properly select patients with malignant effusion for pleurodesis to minimize treatment failure. Unsuccessful pleurodesis my be more problematic and difficult to treat due to conversion of the free effusion into encysted one. The aim of this work is to evaluate the success rate of palliative treatment of malignant pleural effusion comparing talc powder ( either through poudrage or slurry) versus Mistletoe preparation (Viscum Fraxini ~2~). To evaluate also the tolerability of both preparations, coast and the complication rate.

    Methods
    This is a retrospective non randomized study during the period between (Jan. 2008 – Feb 2011). Sixty patients with malignant pleural effusion were included. Patients were divided into 2 groups (30 patients were included in each group) according to the method of pleurodesis used. The first group included patients in whom talc powder ( either through poudrage or slurry) was used for pleurodesis. The second group included patients with Mistletoe preparation (Viscum Fraxini ~2~) used as pleural sclerosant. CT scan of the chest was ordered for all patients prior to treatment. Criteria for potentially successful pleurodesis: There should be no pleural septations or loculation (if present based on CT scan should be lysed pre pleurodesis). The lung should not be entrapped and fully inflated (the presence of residual space will convert the free effusion into encysted one). Response definition : Successful pleurodesis is defined as no recurrence of effusion on clinical and radiologic follow-up 4 weeks after pleurodesis.

    Results
    There were 34 males and 26 females , the mean age was 59 years, right sided effusion was present in 37 patients (61.6%) and left sided effusion in 23 patients (38.4%) . All patients presented with grade I-III dyspnea and 15% also presented with chest pain. In Group I: Twenty three patients had successful pleurodesis (76.7%), while 7 patients showed treatment failure. Treatment related complications developed in 4 patients. In Group II : Pleurodesis was successful in 19 patients (63.3%)(After 2, 6, 7, 8 injections), treatment failure developed in 11 patients after 6 injections. Four patients developed allergic reactions and two patients suffered empyema.

    Conclusion
    Both methods used for pleurodesis were well tolerated by the patients with good success rate with minimal complications. Talc offers higher success rate, less coasty and also considered single use therapy while the use of Mistletoe preparation needs repeated injections.