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Though talc pleurodesis (TP) is not always recognized as a
"treatment" for malignant mesothelioma, some researchers
have shown that unselected survival data is comparable to highly
selected surgical series of combined pneumonectomy, radiation, and
chemotherapy.[1] The Chart "Talc Pleurodesis,"
provides an overview of this treatment option. Most agree that the
TP is very effective in retarding recurrent pleural effusions.
Myths abound about whether a mesothelioma patient post-TP is
eligible for a pleurectomy / decortication, but the truth is a
careful surgeon won't be deterred, unless perhaps the TP
included a lung biopsy or other procedure that opened up the lung
or chest wall to deep tumor invasion.
Chart : Talc pleurodesis
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Title
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Patient Group
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Results
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Conclusions
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Reference
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Thoracoscopic Talc Poudrage in Malignant
Pleural Effusions: Effective Pleurodesis Despite Low
Pleural pH
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25 mesothelioma patients in a prepaid,
closed-panel health maintenance organization
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Pleurodesis was successful in 22 of 25
(88%). There were no thoracoscopy-related deaths.
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TP is an effective technique in malignant
pleural effusions. The short hospital stay and high success
rate make this approach a good choice in palliating
symptomatic malignant pleural effusions.
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Aelony et al,
Chest. 113:1007, 1998.
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Extrapleural Pneumonectomy
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A review of several studies, total patient
group not specified.
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Talc pleurodesis facilitates extrapleural
dissection at the time of EPP and may also prevent
intraoperative spillage of malignant cells that may
increase the risk of local recurrence.
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It is best to proceed with the EPP within
2 to 3 weeks after pleurodesis.
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Miller D, CTSNet, 2003.
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Medical Thoracoscopy (Pleuroscopy)
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A review of several studies, total patient
group not specified.
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Successful prevention of pleural effusions
occurs in 90-100% after talc pleurodesis. Recurrences of
effusions are infrequent. When followed until death, there
was no recurrence
in 81%. Recurrence mean time of 17 months
after pleurodesis.
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Unselected survival data for TP is
comparable to highly selected surgical series of
combined
pneumonectomy, radiation, and
chemotherapy.
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Aelony et al, American Thoracic Society,
2005.
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Prolonged Survival After Talc Poudrage for
Malignant Pleural Mesothelioma
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26 mesothelioma patients from a database
of 228 patients with recurrent pleural effusions.
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Mean survival after TTP was 23.8 +/- 16.3
months (median 19.4, range 2.9-68). Pleurodesis alleviated
dyspnea in all patients. No perioperative deaths and one
postoperative complication (pneumonia) occurred. Mean
hospital stay was 3.9 +/- 2.7 days
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TP remains a safe, low-morbidity,
inexpensive primary palliative treatment option for
malignant pleural mesothelioma and a valid control arm
option for therapeutic trials. TP is ideal for patients who
wish to avoid thoracotomy, long hospital stays and
morbidity from multimodality therapy.
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Aelony Y, Respirology. 10:649, 2005.
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[1] Aelony Y, Thoracoscopic talc poudrage
in malignant pleural effusions: effective pleurodesis despite low
pleural pH, Chest, 1998
*** POSTED ON FEBRUARY 7, 2008 ***
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