Abstract
BackgroundInstillation of sterile graded talc in the pleural space is performed to prevent reaccumulation of malignant pleural effusion after drainage. Talc is thought to encourage pleural adhesions as part of the repair process by provoking inflammation, suggesting that adhesions are less likely to form in patients taking corticosteroids or other drugs with anti-inflammatory effects. However, the relationship between steroid therapy and pleurodesis efficacy remains unclear.Case presentationWe report the outcomes of six patients who underwent pleurodesis at Hiroshima University Hospital while being treated with systemic steroid therapy for non-cancer-related illnesses. Talc pleurodesis was successful at the first attempt in five of the six patients. The five successful cases were receiving low-dose oral prednisolone or methyl prednisolone (range, 1–20 mg/day) at the time of pleurodesis and had serum albumin levels ranging from 2.2 to 3.0 g/dL. In contrast, the patient in whom pleurodesis was unsuccessful was receiving a higher dose of prednisolone (40 mg/day) intravenously and had a relatively low serum album level (1.7 g/dL).ConclusionsThe outcome of pleurodesis may be affected by the dose and/or route of systemic steroid therapy. Further analysis with more patients will be necessary to clarify the relationship between steroid dosage and talc pleurodesis success rate.
Highlights
Instillation of sterile graded talc in the pleural space is performed to prevent reaccumulation of malignant pleural effusion after drainage
The outcome of pleurodesis may be affected by the dose and/or route of systemic steroid therapy
Further analysis with more patients will be necessary to clarify the relationship between steroid dosage and talc pleurodesis success rate
Summary
Pleurodesis is a procedure that aims to reduce or eliminate the pleural space by inducing adhesion of the pleural layers. Male Female Age (years), median (range) SSTa Yes No SST systemic steroid therapy aExcludes steroid inhalants and topical drugs Case presentation This was a retrospective study of patients who were admitted to the Department of Respiratory Internal Medicine or Thoracic Surgery at Hiroshima University Hospital between December 2013 (when insurance coverage of talc pleurodesis was approved in Japan) and March 2017. Case 2 (successful) The patient was a 65-year-old man with lung cancer who was taking oral mPSL (4 mg/day) and the immunosuppressants tacrolimus and everolimus following a living-donor kidney transplant. His medical history included hypertension, hyperuricemia, and hyperlipidemia,
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