Management of malignant pleural effusions with indwelling pleural catheters or talc pleurodesis

Management of malignant pleural effusion typically involves insertion of an indwelling pleural catheter (IPC) or chemical pleurodesis with agents such as talc.

To compare these management strategies with regard to success of pleural effusion management.

A retrospective cohort study was designed comparing patients with malignant and paramalignant pleural effusions and Eastern Cooperative Oncology Group performance status <4 managed with IPC insertion or talc pleurodesis (TP) through tube thoracostomy during noncontemporary three-year periods at a single centre.

The IPC and TP groups comprised 193 and 167 patients, respectively. The pleural effusion control rate at six months was higher in the IPC group (52.7% versus 34.4% in the TP group; P<0.01), but the rate of freedom from catheter at 90 days and pleural effusion at 180 days was not significantly different (IPC 25.8% versus TP 34.4% [P=0.17]). Median effusion-free survival from the date of catheter insertion was significantly longer in the IPC group (101 days versus 58 days in the TP group; log-rank P=0.025). Both procedures were safe.

While the results suggest better pleural effusion control and longer effusion-free survival with IPC insertion compared with TP, the present study had several limitations. Other recent studies have not shown one strategy to be clearly superior to the other.

Both IPC insertion and TP remain acceptable options for the management of malignant pleural effusions.