Optimal Management of Malignant Pleural Effusions

http://www.ncbi.nlm.nih.gov/pubmed/22878823

J Natl Compr Canc Netw. 2012 Aug 1;10(8):975-982.

Optimal Management of Malignant Pleural Effusions (Results of CALGB 30102).

Demmy TL, Gu L, Burkhalter JE, Toloza EM, D'Amico TA, Sutherland S, Wang X, Archer L, Veit LJ, Kohman L; the Cancer and Leukemia Group B.

Source

From the aDepartment of Thoracic Surgery, Roswell Park Cancer Institute and University at Buffalo, Buffalo, New York; bCALGB Statistical Center, Duke University Medical Center, Durham, North Carolina; cDepartment of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York; dDepartment of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina; and eDepartment of Surgery, Upstate Medical University, Syracuse, New York.

Abstract

The optimal strategy to achieve palliation of malignant pleural effusions (MPEs) is unknown. This multi-institutional, prospective, randomized trial compares 2 established methods for controlling symptomatic unilateral MPEs. Patients with unilateral MPEs were randomized to either daily tunneled catheter drainage (TCD) or bedside talc pleurodesis (TP). This trial is patterned after a previous randomized trial that showed that bedside TP was equivalent to thoracoscopic TP (CALGB 9334). The primary end point of the current study was combined success: consistent/reliable drainage/pleurodesis, lung expansion, and 30-day survival. A secondary end point, survival with effusion control, was added retrospectively. This trial randomized 57 patients who were similar in terms of age (62 years), active chemotherapy (28%), and histologic diagnosis (lung, 63%; breast, 12%; other/unknown cancers, 25%) to either bedside TP or TCD. Combined success was higher with TCD (62%) than with TP (46%; odds ratio, 5.0; P = .064). Multivariate regression analysis revealed that patients treated with TCD had better 30-day activity without dyspnea scores (8.7 vs. 5.9; P = .036), especially in the subgroup with impaired expansion (9.1 vs. 4.6; P = .042). Patients who underwent TCD had better survival with effusion control at 30 days compared with those who underwent TP (82% vs. 52%, respectively; P = .024). In this prospective randomized trial, TCD achieved superior palliation of unilateral MPEs than TP, particularly in patients with trapped lungs.