Pleural effusions are a common symptom of pleural mesothelioma.

What is a pleural effusion?

When fluid builds up in the pleural cavity, the space between the inside of the ribcage and the lining of the lungs, this is called a pleural effusion.

Pleural effusions can cause shortness of breath, sharp pains in the chest and a dry cough. They are often seen in people with pleural mesothelioma but can be caused by a range of conditions including pneumonia, congestive heart failure and end-stage kidney disease.

How are pleural effusions treated?

There a few ways a pleural effusion can be treated.

Thoracentesis

  • This is a procedure to remove the fluid which helps to alleviate symptoms. A thoracentesis does not solve the cause of the effusion.

Pleurodesis

  • This is a procedure which first removes the fluid using a thoracentesis, then the cause is addressed. Using talc, the two layers of the lung lining are filled, this causes irritation and inflammation which result in scarring, and which fuses the two layers together. With the layers stuck together with intrapleural scarring, there is nowhere for fluid to build up.

Indwelling pleural catheter (IPC)

  • This method involves a drainage tube being fitted to the chest. The tube remains as long as the patient is troubled by pleural effusions and allows them to drain the fluid regularly.

Pleurodesis vs IPC

Whilst a successful pleurodesis means a mesothelioma patient should not require any further treatment for pleural effusions, it is a painful and invasive procedure. To have a good result, there needs to be inflammation, and this restricts the pain medication that can be prescribed following the procedure. Patients who have had a pleurodesis have said it is painful and uncomfortable.

Due to its invasive nature, patients who have a pleurodesis are usually admitted to hospital for a number of days.

For an IPC, a small tube, around the same diameter as a pencil, is inserted into the chest and it is then kept there for as long as is needed. The patient can then be trained to drain it themselves.

Insertion of an IPC takes between 30 minutes and an hour and provided there are no complications, patients can go home after two hours in recovery.

Difference in results?

A recent study from the University of Hong Kong has looked at whether there is a difference in results of pleurodesis and IPC.

They looked at four clinical trials focused on pleural effusion in mesothelioma. There were nearly 500 patients included in the study and they found that over two months the results were nearly identical.

Paper author,  Maggie Yeung wrote; “Difference in pleurodesis success rate and change in dyspnea scores at 4 and 6 weeks between malignant pleural mesothelioma patients treated with IPC and those treated with TP [talc pleurodesis] for pleurodesis were nonsignificant.”

There was no difference found between the two methods in terms of complications and the only difference they were able to find was that patients had to be hospitalised for less days when they had an IPC rather than pleurodesis.

This is good news for mesothelioma patients as it allows patients to choose the best pleural effusion treatment for them and their lifestyle. Some patients want a permanent solution, even though the initial recovery is longer, whereas others want a quicker procedure that they can ultimately control themselves.

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Source:

Yeung, M, “Indwelling Pleural Catheter Versus Talc Pleurodesis for Malignant Pleural Effusion: A Meta-Analysis”, June 10, 2020, Clinical and Experimental Metastasis, https://my.clevelandclinic.org/health/diseases/17373-pleural-effusion-causes-signs–treatment/diagnosis-and-tests

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