Pleural Effusion in Mesothelioma: Comparing Solutions

A new study says, when it comes to pleural effusion in mesothelioma, the two main solutions are pretty equal – with one exception. 

Pleural effusion is a buildup of fluid in the space around the lungs. Over time, this fluid restricts the lungs and makes it hard to breathe. The problem is common in several types of cancer, including malignant mesothelioma. 

In a new report, Taiwanese and Hong Kong researchers compared the two primary ways of dealing with pleural effusion in mesothelioma. They conclude that the two methods work equally well. But one of them usually means a longer hospital stay.

Understanding Pleural Effusion in Mesothelioma

The pleura are layers of thin membranes that surround the lungs. Pleural mesothelioma tumors start on these membranes. As cancer progresses, fluid can collect in the space between the layers or between the pleura and the lungs. 

Patients usually have to have a chest X-ray, CT scan, or an ultrasound to diagnose pleural effusion in mesothelioma. Analysis of the fluid itself can sometimes help in the diagnosis or prognosis of mesothelioma. 

Almost all mesothelioma patients eventually develop pleural effusion. If left untreated, they may develop a cough, chest pain, and dyspnea or shortness of breath.  

Tools to Combat Lung Fluid Buildup

Doctors have two main tools to deal with this excess fluid. One is to fill in the space between the pleural layers so there is no room for fluid. There are a couple of different ways to do this. The most popular method is talc pleurodesis. 

In talc pleurodesis, surgeons physically fill the space with medical grade talc. Irritation caused by the talc particles triggers scarring. The intrapleural scarring permanently fills in the space.

An indwelling pleural catheter (IPC) is the second tool for dealing with pleural effusion in mesothelioma. This option is less invasive than TP. An IPC is a drainage tube that stays in the chest. Patients can drain the fluid regularly or whenever their symptoms get worse. Some research suggests that draining an IPC daily leads to  better quality of life.

Hospitalization for TP versus IPC

The new study of TP versus IPC analyzed four clinical trials on pleural effusion in mesothelioma. The studies included 500 patients. The researchers found that the two methods were nearly identical in their results. 

“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 for pleurodesis were nonsignificant,” writes author Maggie Yeung with the University of Hong Kong. 

There was also no significant difference in major complications between the two methods. The only difference the team found between the two treatments for pleural effusion in mesothelioma had to do with hospitalization.

“The number of hospital inpatient days was significantly lower among patients who were treated with IPC than among those who were treated with TP,” writes Dr. Yeung. 

But even that difference may not mean much. The team concludes that the difference in hospital days is of “uncertain clinical importance.” 

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