Treatment of malignant pleural effusion with drainage, with and without instillation of talc.

In order to determine whether pleural drainage with talc instillation was better than pleural drainage alone, in the treatment of malignant effusion, the present trial was initiated. Thirty-one patients with malignant pleural effusion and progressive disease, resistant to conventional therapy, were included. All patients had pleural drainage applied. After re-expansion of the lung, half of the patients had talc instilled through the chest tube. Twenty-one of the 31 treated patients were evaluable. After pleural drainage with talc instillation, all of 9 treated patients obtained complete resolution of the effusion and subjective improvement. After pleural drainage alone, 7 of 12 patients obtained complete resolution of the malignant effusion. If it is possible to re-expand the lung during pleural drainage in patients with a malignant pleural effusion, pleurodesis can be obtained in 60% of the treated patients with pleural drainage alone. This study showed a statistically significant improvement in the treatment associated with instillation of talc into the pleural cavity and this was achieved without causing increased discomfort to the patient.