Pleurodesis for Mesothelioma: Hard to Predict Success

Pleurodesis is a procedure often used to help relieve some of the symptoms of pleural mesothelioma, but there is still no way to predict how effective it will be in any individual patient.

That is the conclusion of Australian researchers who performed a retrospective study on 390 mesothelioma patients enrolled in the Western Australian Mesothelioma Registry over 5 years. Just over 42% of those patients underwent pleurodesis. The procedure is used to reduce pleural effusions, the buildup of fluid between the layers of lung lining that can cause shortness of breath, cough, and chest pain.

Pleurodesis for mesothelioma can be performed either surgically or chemically. Surgical pleurodesis involves mechanically irritating the parietal pleura, causing it to swell and adhere to the visceral pleural, closing off the space between them. This may be performed via thoracotomy (an incision into the chest) or thoracoscopy (the less invasive method using an internal camera). Most studies have found greater success and less risk of complications when pleurodesis is done thoracoscopically.

Pleurodesis in mesothelioma patients may also be achieved chemically, by putting a chemical irritant between the pleural layers. The irritant, such as talc or povidone iodine, is introduced through a chest drain. As the space between the pleural layers closes, further fluid accumulation becomes impossible.

The Australian study evaluated the effectiveness of both types of pleurodesis in mesothelioma patients. They looked for procedural failures that required further drainage, overall patient survival, and total time spent in hospital from procedure until death. The study found no discernible difference between the two types of pleurodesis and no way to know how well either of them will work.  Just over 30 percent of all pleurodesis procedures performed on the mesothelioma patients were incomplete and required further drainage.

“No clinical, biochemical or radiographic parameter tested adequately predict pleurodesis outcome,” the study’s authors concluded in a recent issue of Thorax. About half of all patients with metastatic cancer, including those with mesothelioma, develop pleural effusions. Neither this study nor past studies have found an increase in mortality among mesothelioma patients who undergo pleurodesis.

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