Talc pleurodesis improves quality of life of patients with advanced colorectal cancer and malignant pleural effusion.

Introduction: Advanced cancer is frequently complicated by malignant pleural effusion (MPE), which significantly reduces quality of life of patients.MPE is a very uncommon finding in patients with advancer colorectal ancer (CRC). There are several treatment options to treat MPE, including thoracentesis, placement of a long-term indwelling catheter, and talc pleurodesis. In any case, the goal is to achieve successful pleurodesis and relief of symptoms. Talc has long been considered to be one of the safest, cheapest, and most effective agents for promoting pleural symphysis, although the occurrence of acute respiratory distress syndrome and cases of respiratory failure have been reported. Medical Research Council (MRC) dyspnea score, and Karnofsky performance index (KI) are useful in evaluating results. The purpose of this study is to analyze the usefulness of talc poudrage pleurodesis in patients with advanced CRC and symptomatic MPE. Methods: Twelve patients (9 males, 3 females, median age 69 years, range 47-82) with MPE related to advanced CRC underwent video-assisted thoracoscopy (VATS) and pleurodesis with large-particle (mean size 25 μm) talc (Steritalc, Novatech, France) administered by a pneumatic atomizer. Patients with pulmonary infection, unstable respiratory status, cardiac failure, trapped lung syndrome and bad performance status (KI≤30) where excluded from the study. Patients were asked to report their functional limitations by filling the MRC and KI questionnaires before surgery and at discharge. VATS was performed under general anesthesia, with careful aspiration of pleural effusion and division of adhesions. A chest tube was inserted after thoracoscopy and removed when daily output was lower than 70 mL. Results: The average duration of VATS talc pleurodesis was 28±8 minutes, and side-effects were mild ( pain, fever for 2-3 days). Overall, pre- and postoperative KI and MRC score were 60.1±12.2 vs. 72.3±13.2 (95% CI 1.4-22.96, p=0.028), and 4.0 ±0.8 vs. 2.7±1.0 (95% CI 0.53-2.07, p=0.002), respectively. A significant relationship between total amount of preoperative pleural effusion and both KI (R=-0.54, p=0.002) and MRC (R=0.64, p=0.0001) was found. Conclusion: VATS-assisted talc pleurodesis is a feasible and effective treatment of MPE, significantly improving quality of life of patients with advanced CRC.