Twenty-six Cases of Talc Pleurodesis for Malignant Pleural Effusions

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  • タルクによる胸膜癒着術を施行した悪性胸水26症例の臨床的検討

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Background. Talc pleurodesis is the standard treatment worldwide for malignant pleural effusions. In Japan, talc for pleurodesis was only put on the market in December 2013. Therefore, the amount of research targeted at Japanese patients is still small. Objective. To investigate the efficacy and safety, and to analyze risk factors and prognosis, of talc pleurodesis. Methods. We retrospectively analyzed 26 patients with malignant pleural effusions who underwent talc pleurodesis from January 2014 to March 2015 at our institution. All patients underwent talc slurry pleurodesis. We evaluated the efficacy according to the phase II clinical trial that was conducted prior to the sale of talc. In the analysis of the risk factors and prognosis, we entered the patients who died or were lost to follow-up in the "ineffective" group. These analyses used censoring one month after the last administration. Result. Out of the 20 patients who were not dead or lost to follow-up, the treatment was effective for 16 (80%). Out of all 26 patients, 10 patients developed a fever (38%). Other serious adverse events were not observed. Poor performance status (PS) and hypoalbuminemia were significant risk factors for poor outcomes following talc pleurodesis. This suggests that poor general condition is a risk factor for poor prognosis following pleurodesis. In the analysis of prognosis, we assigned patients to two groups, depending on PS and hypoalbuminemia, derived from an ROC curve. The groups of poor PS and hypoalbuminemia were significantly associated with a poor outcome. Conclusion. The results of our investigation on the efficacy and safety of talc pleurodesis confirm the findings of other studies. Patients with a poor general condition were at risk of poor outcomes and prognosis after the treatment. These results suggest that we need to carefully consider the status of the patients and whether we should perform pleurodesis.

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