Malignant pleural effusions: pleural catheters vs pleurodesis, again

Another study shows that indwelling pleural catheters and talc pleurodesis appear equivalent in efficacy, each with its own pros and cons in hospital length of stay and adverse event risk.

Malignant pleural effusions tend to recur increasingly frequently, such that repeated thoracentesis becomes an inviable option. For these patients, talc pleurodesis or placement of an indwelling pleural catheter (e.g., PleurX) are typically advised. The optimal approach has never been clear.

In the latest trial, investigators randomized 146 patients with malignant pleural effusions to undergo either tunneled pleural catheter placement or talc pleurodesis. Patients were about 71 years old on average. Patients receiving pleural catheters did arguably better overall:

• Shorter hospital stays (10 days vs. 12 days);

• Fewer pleural fluid drainage procedures (3 vs. 16 for patients getting talc pleurodesis)

However, indwelling pleural catheters were associated with more adverse events (30% vs. 18%), which were usually mild (catheter blockage, cellulitis).

The results mirrored those in the TIME2 study published in 2012, and other studies we've reviewed: for malignant pleural effusions, either pleural catheter placement or talc pleurodesis are usually successful, but with a different set of downsides for each. Pleural catheters appear to be gaining favor due to their relative ease of placement, shorter hospital stays (sometimes none), and less discomfort for most patients. Most patients with malignant pleural effusions have a life expectancy of less than one year (as was seen in this study); thus, maximizing quality of life and time out of the hospital should drive the counseling approach and shared decision making with these patients. Source: JAMA