title: Optimal management of malignant pleural effusions (results of CALGB 30102).
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.
authors.affiliation: Department of Thoracic Surgery, Roswell Park Cancer Institute and University at Buffalo, Buffalo, New York 14263, USA. Todd.Demmy@roswellpark.org
authors.forename: Todd L
authors.initials: TL
authors.lastname: Demmy
authors.forename: Lin
authors.initials: L
authors.lastname: Gu
authors.forename: Jack E
authors.initials: JE
authors.lastname: Burkhalter
authors.forename: Eric M
authors.initials: EM
authors.lastname: Toloza
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.forename: Susan
authors.initials: S
authors.lastname: Sutherland
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Wang
authors.forename: Laura
authors.initials: L
authors.lastname: Archer
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Veit
authors.forename: Leslie
authors.initials: L
authors.lastname: Kohman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D019468:Disease Management; D004322:Drainage; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D016066:Pleural Effusion, Malignant / Q000209:etiology* / Q000628:therapy*; D018700:Pleurodesis; D011446:Prospective Studies; D011788:Quality of Life; D013627:Talc / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013627:Talc