Survival and Talc Pleurodesis in Metastatic Pleural Carcinoma, Revisited: Report of 125 Cases

doi:10.1378/chest.104.5.1482

Chest

Volume 104, Issue 5, November 1993, Pages 1482-1485

https://doi.org/10.1378/chest.104.5.1482 Get rights and content

Study objective

To find out whether patients with different types of metastatic pleural carcinomas have significant differences in survival, as related to pleural fluid glucose and pH. A second objective was to evaluate the outcome of talc poudrage for pleurodesis.

Design

Cohort analytic prospective study; follow-up of patients from thoracoscopic diagnosis and evaluation to death.

Setting

Pulmonary department at a referral medical center.

Patients

One hundred twenty-five patients with metastatic pleural carcinoma diagnosed by thoracoscopy were evaluated prospectively. One patient was lost to follow-up.

Interventions

Thoracoscopy was performed in every patient, with talc pleurodesis performed at the end of each procedure.

Measurements and results

On the same day as thoracoscopy or the previous day, glucose levels and pH of both the blood and pleural fluid were determined. The outcome of talc poudrage was that pleural effusions were controlled in 104 out of 119 patients (87 percent). Pleurodesis failed in 43 percent (6/14) of the patients with a pleural fluid pH lower than 7.20, as opposed to 9 percent (8/92) of failures in patients with a pH above this limit (p<0.01). Average survival was as follows: nonsmall cell lung cancer (n = 40), 4.3 months (range, 1 to 15 months); small cell lung cancer (n = 8), 3.7 months (1 to 12 months); breast carcinoma (n=30), 7.4 months (1 to 29 months); and ovarian carcinoma (n = 8), 9.4 months (1 to 29 months). There was a significant difference in survival between patients with breast carcinoma and patients with cancer not sensitive to chemotherapy (7.4 vs 4.7 months; p<0.02), although the pleural tumor lesion rating was even greater in the first group. We found no significant differences between lung carcinomas and those from other origins. Patients with a low pleural fluid glucose level and low pH had significantly shorter survival than the group with high glucose and high pH levels (1.9 vs 5.7 months, respectively; p<0.005).

Conclusions

We confirmed our previous data demonstrating poor survival in patients with pleural effusions with low glucose and pH levels. The outcome of talc pleurodesis correlated to these same parameters. These results apply to all kinds of metastatic pleural carcinomas.

Section snippets

Materials and Methods

We studied 125 consecutive patients with metastatic pleural carcinoma who underwent thoracoscopy between 1982 and 1990. The origins and types of the metastatic carcinomas are shown in the following tabulation listing numbers of patients (numbers within parentheses are percents):
Lung 48 (38)
Epidermoid carcinoma 11 (9)
Adenocarcinoma 24 (19)
Large cell carcinoma 3 (2)
Giant cell carcinoma 2 (2)
Small cell carcinoma 8 (6)
Breast 30 (24)
Gastrointestinal tract 11 (9)
Ovary 8 (6)
Kidney 6 (5)
Uterus 3

Results

The results of talc pleurodesis were evaluated in 119 out of 125 patients. We obtained complete results in 82 patients (69 percent) and nearly complete results in another 22 (18 percent), and pleurodesis failed (1 or more thoracenteses needed) in 15 (13 percent). If we consider only patients with or without symptoms due to recurrent pleural effusion, successful pleurodesis was obtained in 104 of 119 patients (87 percent). Pleural fluid pH levels were available in 106 patients, and the level was

Discussion

As metastasis to the pleura is likely to be related to an advanced stage of the neoplastic process itself, the finding of a broad pleural tumor scatter would presumably be associated with poor survival; however, the finding of a higher survival in patients with metastatic breast carcinoma was rather surprising, as they had a pleural tumor burden larger than other groups. This could be explained by differences in tumor aggression among different types of metastases. The lack of significant

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The pathogenesis of low glucose, low pH malignant effusions
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Pleural fluid pH in malignant effusions: diagnostic, prognostic, and therapeutic implications
Ann Intern Med
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There are more references available in the full text version of this article.

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Lung	48 (38)
Epidermoid carcinoma	11 (9)
Adenocarcinoma	24 (19)
Large cell carcinoma	3 (2)
Giant cell carcinoma	2 (2)
Small cell carcinoma	8 (6)
Breast	30 (24)
Gastrointestinal tract	11 (9)
Ovary	8 (6)
Kidney	6 (5)
Uterus	3

Chest

Clinical Investigations: Cancer: Journal ArticleSurvival and Talc Pleurodesis in Metastatic Pleural Carcinoma, Revisited: Report of 125 Cases

Study objective

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Chest

Am J Med

The pathogenesis of low glucose, low pH malignant effusions

Am Rev Respir Dis

Cells, proteins, and the acid-base status of pleural fluid in health and disease

Pleural fluid pH in malignant effusions: diagnostic, prognostic, and therapeutic implications

Ann Intern Med

Clinical Investigations: Cancer: Journal Article
Survival and Talc Pleurodesis in Metastatic Pleural Carcinoma, Revisited: Report of 125 Cases