Monitoring the Effectiveness of Surgical Treatment of Malignant Pleural Effusions

Overview

Backgrounds:
Recurrent pleural effusion occured in 10% of cancer patients. Repeated thoracocentesis or drainage may be complicated by pneumothorax, haemothorax or pleural cavity infection. Thoracoscopic talc poudrage is one of the most effective pleurodesis technique in patients with malignant pleural effusions. The effectiveness of such pleurodesis is reaching the 70 to 90%. This surgical approach also allows to take a biopsy for histological verification of the process. An effort to predict the success rate of chemical pleurodesis on the basis of the body’s general inflammatory reaction rate, which is determined by the dynamics of values of humoral and cellular inflammatory parameters in both serum and in pleural effusion. Patients: In the period 6/2008–12/2009 we applied biotalcum to 14 patients with malignant pleural effusions. The group of patients consisted of 10 male patients and 4 female patients of average age 71 years. Indication to include patients in the group was a second or further thoracic puncture, shortening of the interval between interventions, estimated time of survival > 3 months and the possibility of operation under selective pulmonary ventilation. Method: We performed the collection of pleural effusion and blood serum at 12-hour intervals. The first collection was performed preoperatively before biotalcum application, and then during the time of losses from thoracic drainage bigger than 150 ml in 24 hours. The duration of thoracic drainage was 4 days ± 1 day. The success of the treatment was observed by ultrasound scan before drainage removal; during the first three months always at intervals of 1 month and then after 3 and 6 months, depending on the progression of a disease. Results: No reccurence occured when the P-CRP (pleural) and S-CRP (serum) ratio exceeded 60 % during the first 48 hours after pleurodesis. On the other hand, when the ratio fall bellow 30-35 %, the effusion relapsed frequently. Conclusion: The P-CRP/S-CRP ratio as a promising marker of talc pleurodesis effectiveness and monitoring both P-CRP and S-CRP levels is inexpensive and acceptable method for clinical practice. The pleural effusion caused by malignant mesothelioma appeares to be resistant to talc pleurodesis.

Key words:
malignant pleural effusion – thoracoscopy – biotalcum – CRP