Pleurodesis for Mesothelioma

What Is Pleurodesis?

Pleurodesis is a procedure that aims to stop fluid from building up around the lungs (pleural effusions). Pleural effusions can cause difficulty breathing, dry coughs and chest pain. Pleurodesis seals together the two layers of the lining around the lungs, called the pleura. This closes the space where fluid collects and can help alleviate effusion symptoms.

Pleural effusions may be caused by several conditions but are a common symptom of pleural mesothelioma, affecting more than 90% of patients.

Mesothelioma patients may hear their pleural effusions called “malignant pleural effusions.” In this context, malignant means cancer involves the pleura or cancer cells are present in the pleural fluid.

How Does Pleurodesis Treat Mesothelioma Symptoms?

Pleurodesis eases mesothelioma symptoms by sealing the space around the lung where fluid collects, so the fluid is less likely to return. Pleurodesis does not directly treat mesothelioma. It is a palliative treatment that can improve patients’ quality of life by alleviating symptoms caused by fluid buildup.

Mesothelioma patients with pleural effusions often experience breathing difficulty, chest pain and dry cough. Draining the fluid brings quick relief. Pleurodesis then seals the space so the fluid is less likely to build up again.

If a patient experiences common symptoms of a pleural effusion, their doctor can use chest X-rays or computed tomography (CT) scans to confirm fluid buildup is the problem. If the doctor confirms a pleural effusion, there are several possible treatment options. Pleurodesis, thoracentesis (pleurocentesis) and indwelling pleural catheters are common options to treat pleural effusions.

Pleurodesis vs. Thoracentesis and Indwelling Pleural Catheters

Doctors may recommend thoracentesis, pleurodesis or an indwelling pleural catheter (IPC) to treat pleural effusion. They consider a patient’s individual factors when deciding on the specific treatment.

A thoracentesis, also known as pleurocentesis, drains excess fluid from the pleural space. The procedure may be completed multiple times for symptom relief.

Pleurodesis is a longer-term option because it can prevent fluid from building up again in some patients.

An IPC is another option. It is a thin, flexible tube placed under the skin of the chest. Patients or caregivers drain fluid through it at home.

In the 2012 TIME2 trial, IPCs and talc pleurodesis relieved breathlessness about equally. Patients with an IPC spent fewer days in the hospital and needed fewer repeat procedures, but they had more complications. The 2025 American Society of Clinical Oncology (ASCO) guideline lists both an IPC and pleurodesis as options for pleural mesothelioma patients with symptoms from an effusion.

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Types of Pleurodesis

Doctors may perform a pleurodesis chemically or mechanically. Both types of pleurodesis have unique benefits and risks. For patients who are eligible for pleurodesis, their medical team can determine the best option for their case.

Chemical Pleurodesis

Chemical pleurodesis treats malignant pleural effusions by injecting a chemical substance into the pleural cavity. Most often, doctors use medical-grade talc or doxycycline. They may also use a chemotherapy drug.

Doctors administer the substance through a chest tube. The chemical substance irritates the membranes to cause inflammation and scarring. This helps the tissue adhere together, minimizing further fluid buildup.

The patient may change positions throughout the procedure. The entire procedure can take a few hours to complete. Chemical pleurodesis through a chest tube is often done at the bedside with a local anesthetic to numb the area. Patients also receive pain medicine because the procedure can be painful.

Rapid Pleurodesis

Chemical pleurodesis can sometimes be performed using a method called rapid pleurodesis. In rapid pleurodesis, the doctor sprays talc into the chest during a thoracoscopy (a procedure that uses a small camera) and places an IPC at the same time. The catheter lets fluid drain at home. The goal is a shorter hospital stay and less time with a catheter.

Mechanical Pleurodesis

During mechanical pleurodesis, the surgeon causes inflammation and scarring mechanically. The surgeon brushes the pleural membranes to cause abrasions (scratches) instead of using a chemical substance. As in chemical pleurodesis, the scarring and inflammation help the layers of the pleura stick together. This helps prevent further fluid buildup. Mechanical pleurodesis also requires surgery under general anesthesia.

A small 2015 study included 36 women with breast cancer. It suggested mechanical pleurodesis might give better symptom relief and quality of life than chemical pleurodesis. The study did not include people with mesothelioma, so more research is needed.

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Who Is Eligible for Pleurodesis?

Pleurodesis is usually an option for mesothelioma patients whose pleural effusions keep coming back and whose lung can fully re-expand after drainage. Not every patient is a good candidate.

Patients with a stage 4 mesothelioma diagnosis may not be eligible, but stage alone does not decide it. The most important factor is whether the lung can fully re-expand once the fluid is drained, because the two layers of the pleura must touch to seal. Tumor on the lung lining can keep the lung from expanding. Doctors call this a trapped lung or non-expandable lung. Patients with a trapped lung are usually offered an IPC instead. Doctors also may not recommend pleurodesis for patients expected to live less than about three months.

If the mesothelioma is still localized and the patient is in good health, the patient may have more options. Their mesothelioma specialist may discuss surgery to remove the pleural lining and visible tumor. One example is pleurectomy and decortication (P/D). Removing the lining also removes the space where fluid collects. The 2025 ASCO guideline recommends this surgery only for carefully selected patients. In the 2024 MARS 2 trial, people who had extended P/D plus chemotherapy had less favorable survival at 2 years than those who had chemotherapy alone.

Patients should talk to their doctor about all of their treatment options, including the potential risks and benefits.

Recovery From Pleurodesis

Recovery time and hospitalization following pleurodesis depend on several variables. The overall health of the patient and the type of pleurodesis they received (chemical, mechanical or rapid) can impact recovery.

Patients generally stay in the hospital until their chest tubes can be removed. For chemical or mechanical pleurodesis, this usually takes 2 – 7 days. In the TIME2 trial, patients who had talc pleurodesis through a chest tube stayed a median of four days. Rapid pleurodesis may involve a shorter hospital stay.

Once the chest tube is removed, the wound may continue to drain for 1 – 2 days. Experts advise patients to keep the bandage on during this time.

Patients may also be instructed to keep the area around the incision clean and dry. Some hospitals advise patients to avoid the following:

• Applying creams, ointments or powders on or around the incision
• Scrubbing at the incision or using harsh soaps
• Submerging the wound in water until it is healed

In addition to keeping the wound clean, patients may need to limit activity during recovery. Patients may be told to avoid holding their breath during activities, as this may cause strain. A patient’s healthcare team can advise when it is safe to resume normal activities.

Some hospitals also ask patients to avoid anti-inflammatory pain relievers, such as ibuprofen, for about two weeks. These drugs may weaken the inflammation that helps the lining seal.

Patients should follow up with their doctors about any side effects they experience. Their healthcare team may recommend options to alleviate side effects and aid recovery.

Benefits of Pleurodesis

Pleurodesis does not directly treat mesothelioma. However, the procedure may relieve the following symptoms associated with malignant pleural effusions:

• Chest pain
• Chest tightness
• Dry cough
• Dyspnea (shortness of breath)

Alleviating these symptoms can improve a patient’s quality of life. In a 2012 study of 122 people with pleural mesothelioma, those who had talc pleurodesis tended to live longer. However, the study looked back at past records and could not show that pleurodesis caused the difference. Healthier patients are more often offered the procedure. Pleurodesis is meant to ease symptoms. Patients should not expect it to extend their life expectancy.

A patient’s care team can help them decide if pleurodesis is a safe option to relieve the symptoms of malignant pleural effusions.

Pleurodesis Risks and Complications

As with any medical procedure, there are potential risks associated with pleurodesis. These risks can vary depending on the type of pleurodesis and a patient’s individual case.

Patients may experience some side effects following a pleurodesis, including a fever. This is a result of the inflammatory response of the body to the procedure. Infection is another possible side effect of the procedure. Even the least invasive medical procedure carries a risk of infection. Doctors may recommend antibiotics in these cases.

Although rare, pleurodesis can result in acute respiratory distress syndrome (ARDS) or heart complications. ARDS develops when fluid builds up in the alveoli (air sacs inside the lungs). This buildup prevents the lungs from filling up with air. As a result, patients may experience serious symptoms such as difficulty breathing.

Some patients have developed ARDS after talc pleurodesis. Research links this risk mainly to talc with very small particles or to large doses. In a large 2007 study, no patients developed ARDS when doctors used large-particle talc. Patients can ask their care team what type of talc will be used in their treatment plan.

Talc pleurodesis has also raised a separate concern. Talc is a mineral that can form near asbestos in the earth, and some talc has been contaminated with asbestos during mining. In 2024, a Massachusetts jury awarded $39 million to a man who developed pleural mesothelioma seven years after a talc pleurodesis for a collapsed lung. His lawsuit argued the talc used in his procedure contained asbestos, and the jury found the talc supplier responsible. A judge later reduced the award, and the case is on appeal. Pleurodesis is also used for conditions beyond mesothelioma, such as a collapsed lung, so some people have had talc pleurodesis years before any cancer diagnosis. Anyone diagnosed with mesothelioma after talc pleurodesis may want to speak with a mesothelioma lawyer about their options.