Long-term effect and tolerance of talc slurry for control of malignant pleural effusions

Drainage of malignant pleural effusions (MPE) by thoracocenthesis and subsequent pleurodesis is an established means of symptomatic relief in terminally-ill patients, but the optimal therapy remains unclear. Among many sclerosing agent, talc is the most widely used, but its intrapleural administration and dosage have not been clearly determined. To assess the efficacy of using talc slurry with high dose (8 g) as a sclerosing agent instilled into the pleural space at the patient bedside, we carried out a study in 31 patients suffering from symptomatic MPE, followed until death or up to 1 year with radiographs. Patients were evaluated for immediate tolerance (31 patients), and for efficacy and long-term tolerance (27 patients) of the talc therapy. We have shown, that pleurodesis was satisfactory in 22/27 patients (81.4%). This result appeared comparable with other series. Moreover, we observed a long-lasting efficacy: within 6 months and within 12 months after talc instillations, 20/20 patients and 9/9 patients respectively were symphysed with efficacy. Complications related to talc (8 g) were rare and moderate (pain, fever). Taking into account some technical aspects of talc instillation for good performance of the therapy, we recommend this method as the optimal route of administration.