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Response to Talc Treatment May Predict Mesothelioma Prognosis

23133655_doctors3How well a mesothelioma patient’s lungs respond to a procedure designed to eliminate excess lung fluid may be a better predictor of survival than the stage or subtype of their cancer.

A group of pathologists and thoracic surgeons in Italy came to that conclusion after evaluating the cases of 172 mesothelioma patients who underwent a procedure called talc pleurodesis or talc poudrage. Talc pleurodesis is designed to prevent a buildup of lung fluid that is common in mesothelioma patients and causes unpleasant symptoms like shortness of breath.

After the lung fluid (also called pleural effusion) is drained, the space between the two pleural layers is filled with talc. The talc acts as a chemical irritant causing inflammation and fibrosis which effectively closes off the pleural cavity so that fluid can no longer collect there and restrict the lungs.

According to the study, 146 of the 172 mesothelioma patients studied had complete expansion of their lungs when they left the hospital after their talc pleurodesis. But 3 months later, follow-up chest X-rays showed that only 85 of the patients still had fully-expanded lungs. Median survival among all the patients studied was 11.5 months.

Writing in the Annals of Thoracic Surgery, author and thoracic surgeon Ottavio Rena of the University of Eastern Piedmont in Novara, Italy observed, “Persistent lung expansion after pleural talc poudrage and absence of fluid recurrence is demonstrated to be a stronger factor in predicting survival than clinical stage and other clinical variables.”

Although “persistent lung expansion” was the biggest predictor of outcomes, several other factors were also found to play a role in survival. Patients with non-epithelioid mesothelioma, later stage cancer, higher platelet counts, and poorer overall health had the poorest prognosis.


Rena, O et al, “Persistent Lung Expansion After Pleural Talc Poudrage in Non-Surgically Resected Malignant Pleural Mesothelioma”, February 7, 2015, Annals of Thoracic Surgery, Epub ahead of print

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