Prolonged survival after talc poudrage for malignant pleural mesothelioma: case series.
OBJECTIVE
Malignant pleural mesothelioma is a fatal disease with a mean life expectancy of 6-12 months. Since 1982, we have performed thoracoscopic talc poudrage (TTP) as a primary therapy in mesothelioma patients presenting with pleural effusion. As the survival data for our patients surpassed that of many published series, the patient data was analyzed to determine whether talc poudrage can be considered as a contemporary palliative option.


METHODS
We reviewed all 26 patients with a final diagnosis of malignant pleural mesothelioma from our prospective database of 228 consecutive patients who received thoracoscopy from the same physician for recurrent symptomatic pleural effusion. Patients were followed up until their death.


RESULTS
Mean survival after TTP was 23.8 +/- 16.3 months (median 19.4, range 2.9-68). Pleurodesis palliated dyspnoea in all patients. No perioperative deaths and one postoperative complication (pneumonia) occurred. Mean hospital stay was 3.9 +/- 2.7 days.


CONCLUSIONS
TTP remains a safe, low-morbidity, inexpensive primary palliative treatment option for malignant pleural mesothelioma and a valid control arm option for therapeutic trials. TTP is ideal for patients who wish to avoid thoracotomy, long hospital stays and morbidity from multimodality therapy. Prospective randomized studies are needed to compare quality of life and survival after talc poudrage and other therapies.
Aelony
Yossef
Y
Department of Internal Medicine, Kaiser Permanente Medical Center, Harbor City, CA 90710, USA. y.aelony@cox.net
Yao
Janis F
JF
D000368:Aged; D002140:California / Q000453:epidemiology; D004417:Dyspnea / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D010166:Palliative Care; D010997:Pleural Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018700:Pleurodesis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate; D013627:Talc / Q000008:administration & dosage*; D013906:Thoracoscopy
D013627:Talc