[Indications for intrapleural talc under pleuroscopic control in malignant recurrent pleural effusions. Based on 26...

A review of ten years' experience of talc pleurodesis applied to the treatment of permanently recurrent carcinomatous pleural effusions. Twenty six patients aged between 35 and 83 years, suffering from metastatic pleural effusions, underwent pleuroscopy with local anaesthesia followed by powdering with talc, then suction drainage. There were 8 failures (30%), including 4 early deaths and 4 survivals of less than 4 months with no reduction in the effusion. Three results proved to be poor because of early extra-thoracic metastases (11.5%). There were 15 useful results, with drying up without return of the effusion and comfortable survival for 3 months to 7 years, including 8 of more than a year. These figures, somewhat unfavourable in comparison with those found in the recent literature (up to 90% useful results) were biased by the inclusion of patients who were in fact beyond help (excessive age, markedly impaired general condition, too advanced pleuro-pulmonary lesions, multiple metastases) which represent classical contraindications to the use of the talc technique. It emphasizes the best indications, based upon a sufficiently long life expectancy, good local pleuro-pulmonary state, the virtual restriction of malignant disease to the pleura, residual therapeutic possibilities-all conditions frequently found in cases of pleural carcinomatosis of mammary origin.