Pleurodesis for Mesothelioma

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James Stevenson, M.D. Thoracic Medical Oncologist

Pleurodesis is a procedure that treats pleural effusions, excess fluid around the lungs. Pleural effusions are a common symptom of malignant pleural mesothelioma. Pleurodesis does not cure malignant pleural mesothelioma but can alleviate symptoms, such as difficulty breathing.

01. Pleurodesis Explained

What Is Pleurodesis?

Pleurodesis is a procedure to treat and prevent pleural effusions. Pleural effusions can cause difficulty breathing, dry coughs and chest pain. Pleurodesis collapses the pleural space. This prevents fluid buildup and can help alleviate these symptoms.

What Are Pleural Effusions?

A healthy lung is surrounded by two to four teaspoons of watery fluid to help the lung function. A pleural effusion occurs when too much fluid builds up in the pleural cavity. The pleural cavity is the space between the two membranes that surround the lungs.

Pleural effusions may be caused by several conditions but are a common symptom of pleural mesothelioma. Pleural effusions affect 80 – 95% of pleural mesothelioma patients.

02. Pleurodesis for Mesothelioma Symptoms

How Does Pleurodesis Treat Mesothelioma Symptoms?

Pleurodesis is a procedure for mesothelioma patients with pleural effusion. Pleurodesis does not cure mesothelioma. It is a palliative treatment. The surgery can improve patients’ quality of life by alleviating the symptoms caused by the buildup of fluid.

Mesothelioma patients with pleural effusions may experience breathing difficulty, chest pain and dry cough. Pleurodesis may provide relief of these symptoms by removing the excess fluid.

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

Pleurodesis vs. Thoracentesis

Doctors may recommend a pleurocentesis or thoracentesis to treat pleural effusion depending on an individual’s case.

A thoracentesis, also known as pleurocentesis, drains the excess fluid with a needle. The procedure may be completed multiple times for symptom relief.

A pleurodesis is considered a more long-term solution, as it prevents the recurrence of fluid buildup in some patients.

03. Types of Pleurodesis

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 will 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.

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 must change positions throughout the procedure to fully coat the pleural cavity. The entire procedure may take a few hours to complete. The patient is typically under anesthesia during the procedure to ensure their comfort.

Following the chemical pleurodesis, patients may need to stay in the hospital for five to seven days to recover.

Rapid Pleurodesis

Chemical pleurodesis can sometimes be performed using a method called rapid pleurodesis. The procedure uses alternative methods to drain fluid from the pleural space at a faster rate than a non-rapid pleurodesis. This typically results in a shorter hospital stay.

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. Like chemical pleurodesis, this scarring and inflammation help to adhere the layers of the pleura together. This prevents further fluid buildup.

A study conducted in 2015 suggests mechanical pleurodesis may result in better symptom relief and higher quality of life for patients than chemical pleurodesis.

04. Recovering From Pleurodesis

Recovery From Pleurodesis

Recovery time and hospitalization following a 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.

A patient will be hospitalized until their chest tubes can be removed. For a chemical or mechanical pleurodesis, this process may take approximately five to seven days. Rapid pleurodesis may decrease days spent in the hospital.

Once the chest tube is removed, the wound may continue to drain for one or two 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. As such, patients should:

  • Avoid applying creams, ointments or powders on or around the incision
  • Avoid submerging the wound in water until it is healed
  • Avoid scrubbing at the incision or using harsh soaps

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 health care team can advise when it is safe to resume normal activities.

Patients should follow up with their doctors about any side effects they’re experiencing. Their health care team may recommend options to alleviate side effects and aid recovery.

05. Pleurodesis Benefits

Benefits of Pleurodesis

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

  • Dry cough
  • Feeling of tightness in the chest
  • Difficulty breathing
  • Chest pain
  • Difficulty breathing unless standing or sitting up straight

Alleviating these symptoms can improve a patient’s quality of life. In a 2012 study, researchers found pleurodesis may also extend the life expectancy of mesothelioma cancer patients. Pleural mesothelioma patients in the study who did not undergo treatment only had a median survival of six months. Pleural mesothelioma patients treated with pleurodesis alone had a median survival of 12 months.

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

06. Pleurodesis Risks

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.

Common Risks and Side Effects of Pleurodesis

  • Chest pain or tightness
  • Fever
  • Infection

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.

In some cases, patients may experience more severe side effects. Although rare, pleurodesis can result in acute respiratory distress syndrome (ARDS) or heart complications. Some patients have developed ARDS following a mesothelioma talc pleurodesis. ARDS occurs 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.

For many, the potential benefits of undergoing a pleurodesis outweigh the potential complications. A patient’s care team will help build a treatment plan that’s best for the individual.

07. Eligibility for Pleurodesis

Who Is Eligible for Pleurodesis?

Pleurodesis is most commonly used to treat malignant pleural effusions. However, not all patients with mesothelioma are eligible for pleurodesis.

Patients with a stage 4 mesothelioma diagnosis may not be eligible. In later stages, tumors may be extensive enough to prevent the lung from expanding. As a result, the patient may not be a good candidate for pleurodesis.

If the mesothelioma is still localized and the patient is in good health, the patient may have more options. Their mesothelioma specialist may suggest more aggressive surgeries, including removing the pleural lining to prevent the cancer from spreading. With this treatment plan, symptoms from pleural effusion would also be addressed.

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