THE EFFECTIVENESS OF TALCUM PLEURODESIS AS A METHOD OF TREATMENT OF PATIENTS WITH METASTATIC EXUDATIVE PLEURITIS

Abstract

Talcum pleurodesis is one of the most effective methods of treating malignant pleural effusion. The main point of this technique is to create aseptic inflammation by chemical (talc) way, the result of which is the fusion of visceral and parietal pleura to prevent exudation of fluid into the pleural cavity. Aim: to assess overall survival and quality of life in patients with metastatic exudative pleurisy after performing talcum pleurodesis. Object and methods: the study involved 92 patients with stage IV tumor and exudative metastatic pleurisy (men — 45.6%, mean age 60.7 years; women 55.4%, mean age 59.8 years). Non-small cell lung cancer was diagnosed in 66 people, pleural mesothelioma in 16 patients, and breast cancer in 10 cases. 52 (56.5%) patients who underwent thoracoscopy with pleurodesis and subsequent chemotherapy (CH) were included in the study group. 40 (43.5%) patients who underwent chemotherapy without pleurodesis were included in the control group. Both groups of patients were statistically comparable in terms of the number of patients with a specific tumor nosology and schemes of special treatment (CH). All patients were assessed for qua­lity of life before treatment and after every two cycles of chemotherapy with the help of the EORTC QLQ-C30, EORTC QLQ-LC13 questionnaires, and an assessment of the patient’s general condition using the ECOG scale. Results: 1-year survival in patients undergoing thoracoscopy with pleurodesis was 59.6%, the median survival (MS) was 12 months, and in patients without pleurodesis — 36.8% (MS 9 months, p < 0,05). Patients who underwent pleurodesis received an average of 7 courses of CT (the first and second lines of CH). Patients who did not undergo pleurodesis received an average of 4 courses of CH. Quality of life analysis using the ECOG scale, EORTC QLQ-C30, EORTC QLQ-LC13 (assessment of fatigue, shortness of breath, cough, chest pain, and other symptoms) found that a statistically significant quality of life was better in the group of patients who underwent thoracoscopy with further pleurodesis prior to CH (p < 0.05). Conclusions: the use of talc pleurodesis in patients with metastatic exudative pleuritis contributes to an increase in 1-year patient survival by 22.8% and a MS for 3 months. The result of the use of talc pleurodesis in patients with metastatic exudative pleurisy is a statistically significant improvement in patients’ quality of life (according to the EORTC QLQ-C30 and EORTC QLQ-LC13).