Video-assisted management of malignant pleural effusion in breast carcinoma.
BACKGROUND
Advanced breast carcinoma almost always leads to a malignant pleural effusion, conditioning the performance status of patients and consequently quality of life. The treatment of malignant pleural effusion should be a priority in the management of such patients. The results of video-thoracoscopic approach (VATS) chemical pleurodesis was analyzed in patients with recurrent pleural effusion from breast carcinoma.


METHODS
From October 1998 to June 2004, 71 consecutive patients with breast carcinoma-related pleural effusion were treated by the same thoracic-surgeon team with intracavitary nebulization of 8 g of asbestos-free sterilized talc via VATS. Multiple pleural biopsies were performed to determine biologic characteristics of recurrent disease.


RESULTS
Talc pleurodesis was performed in all cases, with no intraoperative or postoperative complications. Median length of hospital stay was 5 days (range, 5-8). The overall success rate of the surgical procedure was 89% (confidence interval [CI], 79-95%) with a mean follow-up of 22 months (range, 2-81 mos). The overall survival time was 17 months (range, 2-80). Biopsies showed a switch on receptor status and c-erB-2 status from negative (primary tumor) to positive (pleural metastasis) in 11 (15%) patients. In another 7 (9.8%) patients, we obtained completely new information that was hitherto unknown.


CONCLUSIONS
Talc pleurodesis via VATS is an effective and safe procedure that yields a high rate of success at the first attempt and achieves long-term control of malignant pleural effusion due to breast carcinoma. Concomitant biopsies performed during the VATS procedure were a determining factor in the subsequent decision-making process.
Gasparri
Roberto
R
Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
Leo
Francesco
F
Veronesi
Giulia
G
De Pas
Tommaso
T
DePas
Tommaso
T
Colleoni
Marco
M
Maisonneuve
Patrick
P
Pelosi
Giuseppe
G
Galimberti
Viviana
V
Spaggiari
Lorenzo
L
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications*; D002277:Carcinoma / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D018700:Pleurodesis; D013627:Talc / Q000008:administration & dosage*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome
D013627:Talc