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

BACKGROUND: Malignant pleural effusions can cause severe debilitating symptoms 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 catheters has been studied.

OBJECTIVES: To assess the efficacy and safety of small-bore catheter (Pleuracan) thoracostomy combined with talc sclerotherapy for palliative treatment of malignant pleural effusions.

METHODS: Between May 1998 and March 2000, 24 consecutive patients presenting at our inpatient clinic were studied. Follow-up radiography at the end of the 1st month (immediate response) and 3rd month (long-term follow-up) after talc pleurodesis was performed to assess the response rates.

RESULTS: Of the 24 patients included, 2 patients did not show lung expansion after pleural drainage. Two patients died within 30 days after talc pleurodesis and 1 did not undergo 30-day postpleurodesis radiography. The remaining 19 patients made up the study group to assess the response rates (8 men, 11 women). Overall response 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 and 78.6% (CR: 57.2%, PR:2 1.4%) at 90-day follow-up, respectively. One patient reported moderate pain during catheter placement. Four patients experienced mild to moderate pleuritic chest pain, shortness of breath, or both within 4 h after instillation. Seven of the 22 patients (31.8%) had a transient fever (< or =39.0 degrees C) 6-24 h after talc instillation that lasted less than 24 h and was successfully treated with acetaminophen. One patient had significant subcutaneous emphysema that resolved in 24 h. Four patients died because of tumor progress (2 patients in the 1st month and 2 patients between 30 and 90 days).

CONCLUSION: Pleurodesis can successfully be performed via a small-bore catheter in patients with recurrent malignant pleural effusion. To validate the results of the study, a prospective randomized study, comparing this device (Pleuracan) and a 'standard' 16- to 24-french chest drain, should be performed.