Is Silver Nitrate Pleurodesis for Patients with Malignant Pleural Effusion Feasible and Safe When Performed in an Outpatient Setting?
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The purpose of this study was to analyze the effectiveness and safety of silver nitrate pleurodesis (SNP) in patients with recurrent malignant pleural effusion (RMPE) when performed in an outpatient setting.
Materials and Methods
Prospective study including patients with RMPE recruited in a tertiary university-based hospital from February 2008 to June 2009. Elected patients underwent pleural catheter insertion (Day 1) followed by 0.5% SNP (Day 2), and on 7th day the drain was removed. All procedures were performed in an outpatient facility. Pleurodesis was considered successful when no additional pleural procedure was necessary by the 30th day. Complications were registered and graded according to the CTCAE3.0. Quality of life was evaluated before and 30 days after SNP.
A total of 68 patients (54 female, 14 male, mean age: 57.3 years) were included. In addition, 7 had bilateral pleural effusions; therefore, 75 hemithoraces were drained. Also, 5 were excluded, and 70 hemithoraces (63 patients) underwent SNP. During the period of 30 days postpleurodesis, 8 deaths not related to the procedure occurred, and we lost contact with 10 patients who were followed elsewhere. At the 30th day, 48 hemithoraces (45 patients) were reevaluated, and 2 recurrences observed. The most frequent complication was pain—graded as 3 or more in 7 patients; infection occurred in 2 patients. Physical and environmental aspects of quality of life improved significantly after pleurodesis.
In this study, SNP could be performed safely in an outpatient setting, with pain the most frequent complication. Recurrences occurred in 4% of the patients.
- Lynch TJ Jr. Management of malignant pleural effusions. Chest. 1993;103:385S–9S.
- Neto JD, de Oliveira SF, Vianna SP, Terra RM. Efficacy and safety of iodopovidone pleurodesis in malignant pleural effusions. Respirology. 2010;15:115–8. CrossRef
- de Campos JR, Vargas FS, de Campos Werebe E, Cardoso P, Teixeira LR, Jatene FB, et al. Thoracoscopy talc poudrage: a 15-year experience. Chest. 2001;119:801–6. CrossRef
- Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med. 1994;120:56–64.
- Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions (Cochrane Review). In: The Cochrane Library. Issue 4, 2004. Oxford: Updated Software.
- Kennedy L, Rusch VW, Strange C, Ginsberg RJ, Sahn SA. Pleurodesis using talc slurry. Chest. 1994;106:342–6. CrossRef
- Werebe EC, Pazetti R, Milanez de Campos JR, Fernandez PP, Capelozzi VL, Jatene FB, Vargas FS. Systemic distribution of talc after intrapleural administration in rats. Chest. 1999;115:190–93. CrossRef
- de Campos JR, Werebe EC, Vargas FS, Jatene FB, Light RW. Respiratory failure due to insufflated talc. Lancet. 1997;349:251. CrossRef
- Rehse DH, Aye RW, Florence MG. Respiratory failure after talc pleurodesis. Am J Surg. 1999;177:437–40. CrossRef
- Janssen JP, Collier G, Astoul P, Tassi GF, Noppen M, Rodriguez-Panadero F, et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet. 2007;369:1535–9. CrossRef
- Genofre EH, Vargas FS, Acencio MM, Antonangelo L, Teixeira LR, Marchi E. Talc pleurodesis: evidence of systemic inflammatory response to small size talc particles. Respir Med. 2009;103:91–7. CrossRef
- Maskell NA, Lee YC, Gleeson FV, Hedley EL, Pengelly G, Davies RJ. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004;170:377–82. CrossRef
- Ferrer J, Montes JF, Villarino MA, Light RW, Garcia-Valero J. Influence of particle size on extrapleural talc dissemination after talc slurry pleurodesis. Chest. 2002;122:1018–27. CrossRef
- Paschoalini M da S, Vargas FS, Marchi E, Pereira JR, Jatene FB, Antonangelo L, et al. Prospective randomized trial of silver nitrate vs talc slurry in pleurodesis for symptomatic malignant pleural effusions. Chest. 2005;128:684–9. CrossRef
- Vargas FS, Teixeira LR, Vaz MA, Carmo AO, Marchi E, Cury PM, et al. Silver nitrate is superior to talc slurry in producing pleurodesis in rabbits. Chest. 2000;118:808–13. CrossRef
- Saffran L, Ost DE, Fein AM, Schiff MJ. Outpatient pleurodesis of malignant pleural effusions using a small-bore pigtail catheter. Chest. 2000;118:417–21. CrossRef
- Spiegler PA, Hurewitz AN, Groth ML. Rapid pleurodesis for malignant pleural effusions. Chest. 2003;123:1895–8. CrossRef
- Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0, DCTD, NCI, NIH, DHHS, March 31, 2003 (http://ctep.cancer.gov), Publish Date: August 9, 2006.
- The WHOQoL Group. The development of the World Health Organization quality of life assessment instrument (the WHOQoL). In: Orley J, Kuyken W, eds. Quality of Life Assessment: International Perspectives. Heidelberg: Springer Verlag, 1994.
- Fleck MPA, Leal OF, Louzada S, Xavier M, Chachamovich E, Vieira G, et al. Desenvolvimento da versão em português do instrumento de avaliação de qualidade de vida da OMS (WHOQoL-100) 1999. Rev Bras Psiquiatr. 1999;21:19–28. CrossRef
- Wied U, Andersen K, Schultz A, Rasmussen E, Watt-Boolsen S. Silver nitrate pleurodesis in spontaneous pneumothorax. Scand J Thorac Cardiovasc Surg. 1981;15:305–7.
- Wied U, Halkier E, Hoeier-Madsen K, Plucnar B, Rasmussen E, Sparup J. Tetracycline versus silver nitrate pleurodesis in spontaneous pneumothorax. J Thorac Cardiovasc Surg. 1983;86:591–3.
- Vargas FS, Teixeira LR, Silva LM, Carmo AO, Light RW. Comparison of silver nitrate and tetracycline as pleural sclerosing agents in rabbits. Chest. 1995;108:1080–3. CrossRef
- Vargas FS, Antonangelo L, Capelozzi V, Vaz MA, Genofre EH, Marchi E, et al. Lung damage in experimental pleurodesis induced by silver nitrate or talc: 1-year follow-up. Chest. 2002;122:2122–6. CrossRef
- Terra RM, Teixeira LR, Bibas BJ, Pego-Fernandes PM, Vargas FS, Jatene FB. Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status. Clinics. 2011 [Epub ahead of print].
- Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest. 2006;129:362–8. CrossRef
- Warren WH, Kim AW, Liptay MJ. Identification of clinical factors predicting Pleurx catheter removal in patients treated for malignant pleural effusion. Eur J Cardiothorac Surg. 2008;33:89–94. CrossRef
- Is Silver Nitrate Pleurodesis for Patients with Malignant Pleural Effusion Feasible and Safe When Performed in an Outpatient Setting?
Annals of Surgical Oncology
Volume 18, Issue 4 , pp 1145-1150
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- 1. Thoracic Surgery Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
- 2. University of São Paulo Medical School, São Paulo, Brazil
- 3. Pulmonology Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil