What are the alternative treatments to pleurodesis (pleural sclerosis) for malignant pleural effusion?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Tunneled pleural catheters (TPC) were approved by the FDA in 1997 and are a valid alternative for pleurodesis in malignant and some benign effusions. [56] TPC can be inserted as an outpatient procedure and can be intermittently drained at home, minimizing the amount of time spent in the hospital for patients with short prognoses. In contrast to pleurodesis, they can be used for patients with effusions and trapped lungs. [53]

Both talc pleurodesis and TPC improve dyspnea when used for malignant effusions, but talc pleurodesis requires significantly more days spent in the hospital and more pleural procedures. [46, 57] Consequently, TPC is the most cost-effective approach for patients with malignant effusions with expected survival of greater than 3 months. [58] The combined use of thoracoscopic talc poudrage and simultaneous placement of TPC for rapid pleurodesis has been reported to have a 92% success rate and 1.79 days median hospitalization stay following the procedure. [59]

TPC has also been shown to palliate refractory symptoms from recurrent effusions due to class III or IV heart failure, with effectiveness similar to thoracoscopic talc pleurodesis and with significantly fewer hospital days, operative morbidity, and readmissions. [60]


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