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). Effusions are a common symptom of malignant pleural mesothelioma. Pleurodesis does not treat the cancer. But it can alleviate symptoms, like pain and difficulty breathing.

01. Pleurodesis Explained

What Is Pleurodesis?

Pleurodesis is a procedure that aims to prevent swelling around the lungs (pleural effusions). Pleural effusions can cause difficulty breathing, dry coughs and chest pain. Pleurodesis collapses the layers of the lining surrounding the lungs. This prevents fluid buildup and can help alleviate effusion symptoms.

What Is a Pleural Effusion?

A pleural effusion is swelling in the pleural cavity. The pleural cavity is the space between the two layers of the lining around the lungs (the pleura). When excess fluid collects here, it can press on the lungs and cause breathing problems.

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.

Mesothelioma patients may hear their pleural effusions called “malignant pleural effusions.” Malignant here means the fluid buildup is the result of cancer.

02. Pleurodesis for Mesothelioma Symptoms

How Does Pleurodesis Treat Mesothelioma Symptoms?

Pleurodesis is a procedure for mesothelioma patients with pleural effusion. Pleurodesis does not directly treat 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 often 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 can 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. 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.

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 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 to fully coat the pleural cavity. The entire procedure can take a few hours to complete. The patient is typically under anesthesia to ensure their comfort.

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 can result 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 helps prevent 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.

Patients generally stay in the hospital until their chest tubes can be removed. For a chemical or mechanical pleurodesis, this process may take approximately 2 – 7 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 recommend not:

  • 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.

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.

05. Pleurodesis Benefits

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, 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 6 months. Pleural mesothelioma patients treated with pleurodesis alone had a median survival of 11 – 14 months.

A patient’s care team can help them decide if 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.

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.

Reported Risks and Side Effects of Pleurodesis

  • Abnormal heart rhythms (arrhythmias)
  • Acute respiratory distress syndrome (ARDS)
  • Acute respiratory failure
  • Air leaks (from the lung into the chest)
  • Air trapped under the skin (subcutaneous emphysema)
  • Breathlessness
  • Chest pain or tightness
  • Death (rare)
  • Fatigue
  • Fever
  • Infection
  • Low blood oxygen

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.

A patient’s care team can 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.

08. Common Questions

Common Questions About Pleurodesis for Mesothelioma

Is pleurodesis a major operation?

Pleurodesis may be a minor or major operation. Overall patient health and type of pleurodesis (chemical, rapid or mechanical) may affect whether the surgery is considered minor. In general, the differences between major and minor surgery come down to risk of complications and recovery time.

What is life expectancy after pleurodesis?

Studies report pleural mesothelioma patients who receive pleurodesis have a median overall survival of 11 – 14 months. Patients who receive only pleurodesis have a 1-year survival rate of 18% – 57% and a 2-year survival rate of 10% – 13%. Surgery in addition to pleurodesis may help improve survival.

What are the pros and cons of pleurodesis?

Like with any medical procedure, pleurodesis carries certain risks. Following pleurodesis, patients may experience fever or infection. Serious side effects are rare but can happen. Pleurodesis can help improve quality of life for patients by relieving pleural effusion symptoms, like difficulty breathing.