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A.L. Paiva
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P1.11 - Poster Session/ Palliative and Supportive Care (ID 229)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.11-008 - What Happens to the Pleural Space Affected by Malignant Effusion after Bedside Pleurodesis? (ID 439)
09:30 - 09:30 | Author(s): A.L. Paiva
- Abstract
Background:
The treatment of recurrent malignant pleural effusion (RMPE) has a palliative purpose. Pleurodesis is the most used method. However, not all the procedures are effective, in part because of the lung entrapment by the visceral pleura, preventing the contact between the pleural surfaces. The behavior of the pleural cavities submitted to pleurodesis has not been studied more objectively to date. Moreover, how evolve cases with good initial lung expansion and those with poor expansion?
Methods:
Prospective study including 131 patients with recurrent malignant pleural effusion candidates for treatment with bedside pleurodesis with silver nitrate or mineral talc. Each patient underwent two chest CT scans, one right after the drainage (CT1) and another 30 days after pleurodesis (CT30). A thoracic radiologist has calculated pleural volume using the software Aquarius Intuition Viewer® (Terarecon). The evaluation of lung expansion was based on residual pleural volume on CT1 and the radiological evolution on the difference between the pleural volumes on CT30 and CT1 (Delta volume). The pleural volumes on CT1 were arbitrarily classified into small cavity after the drainage (volume <500mL) and large cavity after the drainage (volume ≥500 mL). After that, the Delta volume was classified in unchanged (≥-268.77 and ≤254,49 mL), negative (<-268.77 mL) and positive (> 254.49 mL). For such we used the average of the numerical variable and half of the standard deviation upwards and downwards. The clinical effectiveness was evaluated as the need for additional procedures to control symptoms.
Results:
We evaluated 87 patients of a total of 131 recruited. The median pleural volume on CT1 was 377 (IR: 171-722) mL and 386 (IR: 164-726) mL on CT30, and has no significant difference between them (p= 0.753). The clinical effectiveness was observed in 86.2% of patients. We found 54 patients (62.06%) in the small cavity after the drainage group and 33 (37.93%) in the large cavity group. Clinical effectiveness was 92.6% and 75.8% respectively. There was significant difference (p= 0.051), with an odds ratio of 4.00 (CI: 1.098 to 14.570) in favor of the small cavity. Among patients with small pleural cavity, 27.77% progress with a significant accumulation of fluid, 66.66% did not show significant changes and 5.55% have decreased pleural volume. Clinical effectiveness was 86.7%, 94.4% and 100% respectively with no significant difference (p= 0.552). Among patients with large pleural cavity, 21.21% progress with an even greater volume of pleural cavity, 27.27% did not show significant changes and the majority (51.51%) evolves with a decrease in the pleural volume. Clinical effectiveness was 57.1%, 77.8% and 82.4% respectively with no significant difference (p= 0.418).
Conclusion:
Almost two third of the patients with RMPE treated with pleurodesis had good lung expansion, while just over one-third had a bad one. Those with good expansion had 4 times higher chances of clinical success. Among poor lung expansion patients, more than half had significant reduction of pleural volume in 30 days, while a fifth had a significant accumulation.
