Pleurodesis
Pleurodesis for Mesothelioma: A Comprehensive Guide to Pleural Effusion Management
Executive Summary
Pleurodesis is a medical procedure that permanently seals the pleural space to prevent fluid reaccumulation in patients with malignant pleural effusion (MPE), a near-universal complication of pleural mesothelioma.[1] Talc remains the gold standard sclerosing agent, with meta-analyses of over 1,500 patients confirming its superiority over alternative agents.[2][3] However, pleurodesis success in mesothelioma is significantly lower than in other cancers — just 68.2% compared to 84.4% in breast cancer — due to higher rates of trapped lung and tumor burden on pleural surfaces.[4]
The treatment landscape has shifted dramatically since the 2012 TIME2 trial, with the BTS 2023 guidelines now recommending indwelling pleural catheters (IPCs) as a first-choice management option alongside pleurodesis.[5][6] Key randomized controlled trials collectively demonstrate that IPCs and talc pleurodesis offer equivalent symptom relief, with IPCs providing shorter hospital stays and pleurodesis offering higher rates of pleural space obliteration.[7][8] For mesothelioma patients, treatment selection depends on lung expandability, expected survival, patient preference, and whether simultaneous diagnostic biopsies are needed.[9][10]
Key Facts
| Key Facts: Pleurodesis for Mesothelioma |
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What Is Pleurodesis?
Pleurodesis is the deliberate obliteration of the pleural space by creating adhesion between the visceral and parietal pleura, preventing fluid reaccumulation. The procedure works by instilling a sclerosing agent — or performing mechanical abrasion — that triggers an intense inflammatory reaction, progressing through fibrosis and ultimately resulting in pleural symphysis, the permanent fusion of the two pleural layers.[1] Talc has additionally been demonstrated to possess a local antitumor effect by triggering apoptosis in cancer cells and altering the angiostatic balance, suggesting it may play a role in controlling intrapleural tumor progression.[1]
Malignant pleural effusion is a near-universal complication of pleural mesothelioma, causing disabling dyspnea that severely impacts quality of life. In the United States alone, MPE accounts for more than 125,000 hospital admissions per year, with 57% requiring pleural procedures and 25% needing readmission within 30 days.[13][15] After simple thoracentesis (fluid drainage), malignant pleural effusions recur rapidly — commonly within 30 days — making definitive management essential.[13][10]
| "For mesothelioma patients, managing pleural effusions is one of the most important quality-of-life interventions available. The goal is to prevent fluid from reaccumulating so patients can breathe more easily and spend less time in the hospital." |
| — David Foster, Patient Advocate, Danziger & De Llano |
When Is Pleurodesis Performed in the Treatment Timeline?
The optimal approach for mesothelioma patients with MPE is maximal drainage of the effusion followed by pleurodesis. The procedure can be performed before, during, or after chemotherapy, with early intervention reducing the risk of later non-expandable lung development. During VATS pleurodesis, simultaneous staging biopsies can be obtained, providing tissue for histological diagnosis and guiding subsequent treatment planning — a particularly valuable dual benefit for newly diagnosed mesothelioma patients.[18][19][9]
How Is Pleurodesis Performed?
There are three principal approaches to pleurodesis, each suited to different clinical situations and patient needs.
VATS Talc Poudrage
Video-assisted thoracoscopic surgery (VATS) pleurodesis is performed under general anesthesia with single-lung ventilation. Two to three ports are placed in the chest wall, allowing complete evacuation of the effusion, direct visualization of the pleural cavity, and simultaneous biopsy for staging. The surgeon then insufflates 2-5 grams of calibrated talc (particle size >15 µm) directly onto the pleural surfaces using a powder atomizer. A chest tube is placed at the conclusion of the procedure, and the typical hospital stay ranges from 3 to 7 days.[14][18]
VATS offers the significant advantage of simultaneous diagnostic biopsies, which is particularly valuable for mesothelioma where tissue diagnosis and staging guide all subsequent treatment decisions. The ability to directly visualize the pleural cavity also allows the surgeon to assess the extent of tumor involvement and identify trapped lung before committing to pleurodesis.[18][20]
Bedside Talc Slurry (Medical Pleurodesis)
Bedside pleurodesis is preferred for patients too ill for general anesthesia or those who are not surgical candidates. After chest tube placement and complete fluid drainage — typically waiting until daily output falls below 150-200 mL — talc slurry (5 grams of talc mixed in 50-150 mL normal saline) is instilled through the drain. The chest tube is clamped for 1-2 hours post-instillation to allow the agent to distribute across pleural surfaces. The tube is removed once drainage ceases and radiographic imaging confirms pleural apposition.[21][11]
Talc Poudrage vs Talc Slurry — What Does the Evidence Show?
The TAPPS trial (2019) — the largest randomized trial comparing these two delivery methods with 330 patients — found no significant difference in pleurodesis failure rate at 90 days: 22% for talc poudrage versus 24% for talc slurry (adjusted OR 0.91; 95% CI 0.54-1.55; p=0.74). No statistically significant differences were found in any of the 24 prespecified secondary outcomes.[12]
| Delivery Method | Setting | Success Rate | Key Trial | Advantages |
|---|---|---|---|---|
| Talc Poudrage | VATS (operating room) | 78% (30-day) | Dresler 2005 (n=242)[22] | Simultaneous biopsy, direct visualization |
| Talc Slurry | Bedside (chest tube) | 71% (30-day) | Dresler 2005 (n=240)[22] | No general anesthesia, lower complication rate |
| No difference at 90 days | Both | 22% vs 24% failure | TAPPS 2019 (n=330)[12] | Largest head-to-head RCT to date |
The earlier Dresler Phase III intergroup study (2005, n=501) also found no overall difference, though a subgroup of patients with lung or breast cancer had higher success with poudrage (82% vs 67%). Respiratory complications were more common following poudrage (14% vs 6%).[22]
What Sclerosing Agents Are Used for Pleurodesis?
Several sclerosing agents have been studied for chemical pleurodesis, with talc consistently demonstrating the highest success rates.
| Agent | Success Rate | Key Evidence | Cost per Treatment |
|---|---|---|---|
| Talc (graded) | 70-95% | Gold standard; RR 1.21 vs controls (20 trials, n=1,525)[2] | ~$12 |
| Bleomycin | 70-79% | Talc superior: RR 1.22 (95% CI 1.05-1.42)[3] | ~$956 |
| Doxycycline | 74-83% | Better long-term results than bleomycin; comparable to talc[23][24] | Low |
| Povidone-Iodine | 82-96% | Average 90.6% across 265 patients (6 studies)[25][26] | Very low |
| Tetracycline | ~80% | Largely replaced by doxycycline (better availability)[27] | Low |
A 2021 meta-analysis of 24 studies confirmed talc pleurodesis had statistically significantly higher successful pleurodesis rates compared to all controls (RR 1.15; 95% CI 1.00-1.31) and specifically versus bleomycin (RR 1.22; 95% CI 1.05-1.42). At time points beyond one month, talc superiority became even more pronounced (RR 1.62; 95% CI 1.15-2.27).[3] Only graded talc (particle size >15 µm) should be used; ungraded talc with approximately 50% particles below 15 µm markedly increases the risk of acute respiratory distress syndrome (ARDS).[14][28]
Mechanical pleurodesis — abrasion of the parietal pleura with dry gauze during VATS — creates a raw surface that promotes adhesion. A comparison of mechanical and chemical pleurodesis showed very similar outcome profiles, with modest evidence suggesting lower recurrence rates with chemical talc pleurodesis.[29]
How Effective Is Pleurodesis in Mesothelioma?
Pleurodesis success in mesothelioma is significantly lower than in other cancers, a critical consideration for treatment planning. In a large study of thoracoscopic talc pleurodesis with an overall response rate of 88%, success rates varied dramatically by tumor type.[4]
| Primary Tumor | Overall Success | Complete Response |
|---|---|---|
| Breast cancer | 84.4% | 75.0% |
| Other tumors | 87.8% | 73.5% |
| Lung cancer | 72.3% | 58.1% |
| Mesothelioma | 68.2% | 53.3% |
The difference between mesothelioma/lung cancer and breast/other cancers was statistically significant (p=0.009 for overall success; p=0.029 for complete response).[4] A systematic review of 49 articles found mean survival of 14 months after talc pleurodesis in mesothelioma, compared to 17 months for pleurectomy/decortication (P/D) and 24 months for extrapleural pneumonectomy (EPP).[16][10]
What Predicts Pleurodesis Success?
A 2020 systematic review and meta-analysis of 34 studies (4,626 patients) identified the strongest predictors of pleurodesis success:[30]
- Higher pleural fluid pH — the strongest predictor; pH below 7.2 is associated with failure
- Smaller effusion volume before the procedure
- Full lung re-expansion after drainage
- Shorter duration of tube drainage
- Higher pleural fluid glucose / lower LDH
- Lower pleural tumor burden
Notably, chest tube size did not affect the outcome.[30]
The LENT Prognostic Score
The LENT score (LDH, ECOG performance status, Neutrophil-to-lymphocyte ratio, Tumor type) is the first validated prognostic scoring system for MPE, significantly superior to ECOG performance status alone at predicting survival.[31]
| LENT Risk Category | Median Survival | 1-Month Survival | 6-Month Survival |
|---|---|---|---|
| Low risk | 319 days | 100% | 86% |
| Moderate risk | 130 days | — | — |
| High risk | 44 days | 65% | 3% |
The LENT score has been independently validated across multiple populations with AUC values of 0.77 (1-month), 0.84 (3-month), and 0.85 (6-month).[31][9]
What Is the Trapped Lung Problem?
Non-expandable lung (NEL), also called trapped lung, is the primary reason for pleurodesis failure in mesothelioma and represents one of the most important clinical considerations when choosing between pleurodesis and indwelling pleural catheter placement.[32]
Approximately 30% of patients with malignant pleural effusion have non-expandable lung, with incidence varying significantly (17-34%) between centers.[13][33] In mesothelioma specifically, trapped lung is more common than in other cancers because the tumor itself creates a thick visceral pleural peel that physically prevents the lung from expanding to fill the pleural space after fluid drainage.[19][20]
NEL is an independent risk factor for shorter survival in mesothelioma patients. Pleural elastance (PEL) measurement can predict pleurodesis outcome: a PEL value greater than 14.5 cm H₂O/L predicts pleurodesis failure with 93% sensitivity and 100% specificity.[33][32]
| Clinical Note: About 29% of patients with significant non-expandable lung eventually achieve pleurodesis at 6 months, suggesting that some degree of non-expansion does not universally preclude success. However, for patients with clearly trapped lung, guidelines consistently recommend indwelling pleural catheter placement over pleurodesis.[34][35] |
The presence of bulky tumor in the pleural space or entrapment of the lung by a thick visceral pleural peel is a contraindication to pleurodesis. Additionally, pleurodesis adhesions may complicate future surgical planes for patients being considered for extrapleural pneumonectomy (EPP), though this is increasingly less relevant as P/D has largely replaced EPP in current practice.[19][36]
What Are the Risks and Complications of Pleurodesis?
The Graded Talc Safety Revolution
The shift from ungraded to graded (calibrated) large-particle talc represents one of the most important safety advances in pleurodesis history. Ungraded talc — with approximately 50% of particles smaller than 15 µm — was associated with systemic absorption and ARDS, with respiratory failure rates of 5.3% in some series and mortality of 2%.[14][28]
The adoption of large-particle talc (greater than 15 µm mean particle size of 24.5 µm) effectively eliminated this complication. In the landmark European safety study of 558 patients across 13 hospitals using large-particle talc at a 4-gram dose, zero cases of ARDS were reported. Eleven patients (2%) died within 30 days, all attributed to underlying disease rather than the procedure.[14]
Complication Rates
| Complication | Incidence | Notes |
|---|---|---|
| Fever | Common (expected) | Talc-related febrile reaction; self-limiting |
| Chest pain | 23-36% | Managed with analgesia[25] |
| Respiratory complications | 6% (slurry) to 14% (poudrage) | Higher with VATS approach[22] |
| ARDS | <1% (graded talc) | Zero cases in 558-patient European study[14] |
| Empyema | 1-4% | Risk increases with incomplete lung expansion[37] |
| 30-day mortality | ~2% | Attributable to underlying disease[14] |
| Re-intervention rate | ~22% | Pooled failure rate across studies; 2-6% with IPC[38] |
Risk factors for ARDS even with large-particle talc include older age (median 80 vs 66 years, p=0.02) and underlying interstitial abnormalities on chest CT.[39] Antibiotic therapy prior to talc slurry pleurodesis may increase the risk of developing empyema, and pleurodesis should be considered with caution in patients with prolonged chest tube placement and incomplete lung expansion.[37][11]
How Does Pleurodesis Compare to Indwelling Pleural Catheters?
The comparison between pleurodesis and IPCs has been extensively studied in multiple randomized controlled trials, fundamentally changing how clinicians approach malignant pleural effusion management.[40]
Key Randomized Controlled Trials
| Trial | Year | Patients | Key Finding |
|---|---|---|---|
| TIME2 | 2012 | 106 | No difference in dyspnea at 42 days; IPC shorter hospital stay (0 vs 4 days); IPC better dyspnea at 6 months[5] |
| AMPLE | 2017 | 146 | IPC reduced hospital days (6.5 vs 18.0 median); fewer re-interventions with IPC[7] |
| IPC-PLUS | 2018 | 154 | IPC + outpatient talc achieved significantly higher pleurodesis at 35 days vs IPC alone[8] |
| SWIFT | 2022 | 119 | Silver nitrate-coated IPC did not improve pleurodesis efficacy[41] |
| TACTIC | 2026 | Multi-center | Thoracoscopic talc poudrage + IPC reduced hospital stay vs TTP alone[42] |
A systematic review and meta-analysis of over 500 patients across five RCTs confirmed that IPCs are associated with shorter procedure-related hospital stay, lower risk of ipsilateral pleural re-interventions, and higher risk of cellulitis, with no differences in dyspnea or survival. The pooled pleurodesis failure rate was 22.1% compared to only 8.9% re-intervention rate in IPC patients.[40][43]
When to Choose Pleurodesis vs IPC
| Factor | Favors Pleurodesis | Favors IPC |
|---|---|---|
| Lung expansion | Expandable lung | Non-expandable / trapped lung[35] |
| Patient preference | Prefers one-time procedure | Prefers ambulatory management[44] |
| Prognosis | Longer expected survival | Shorter survival (<6-14 weeks) — IPC more cost-effective[15] |
| Hospital tolerance | Can tolerate inpatient stay | Wants to minimize hospital time[5] |
| Previous pleurodesis | — | Failed pleurodesis[35] |
| Loculation | Few or no loculations | Loculated effusion[44] |
The Combined Approach — IPC Plus Talc
The IPC-PLUS trial established that outpatient talc administration through an IPC achieves significantly higher pleurodesis rates than IPC alone, with no significant complications. This combination approach is now acknowledged by the ATS/STS/STR guideline as a viable management strategy. The ongoing AMPLE-3 trial is the first to compare IPC (with or without talc) versus VATS pleurodesis in patients fit for surgery, with mesothelioma stratified as a subgroup.[8][35][45][10]
Spontaneous pleurodesis occurs in 40-51% of IPC patients at a median of 59-80.5 days, allowing catheter removal. Daily drainage accelerates pleurodesis rates compared to symptom-guided drainage — in patients with non-expandable lung, aggressive daily IPC drainage achieved spontaneous pleurodesis in 50% at 6 months versus only 7.1% with symptom-guided drainage.[45][13]
What Is the Quality of Life After Pleurodesis?
Both pleurodesis and IPC achieve clinically significant dyspnea improvement. The TIME2 trial demonstrated that more than 75% of patients in both groups achieved clinically meaningful improvement in breathlessness, measured using visual analog scale (VAS) scores and the EORTC QLQ-C30 quality of life instrument.[5][46]
At 6 months post-intervention, the TIME2 trial showed a clinically and statistically significant decrease in dyspnea favoring the IPC group (mean VAS difference -14.0 mm; 95% CI -25.2 to -2.8; p=0.01). However, overall quality of life was comparable between groups. A meta-analysis of four randomized controlled trials found no apparent difference in quality of life between talc pleurodesis and IPC.[47][5][9]
The success rate of talc pleurodesis decreases over time. In the Dresler study, the success rate at 1 month was approximately 75%, but progressively reduced to approximately 50% at 6 months.[27][48] This declining efficacy over time is an important consideration when counseling mesothelioma patients about their options.[36]
What Does Pleurodesis Cost?
A 2024 population-based study — the first to use routinely collected data for comprehensive cost comparison — found significant differences in healthcare utilization between the two approaches.[15]
| Cost Category | IPC (Mean) | Pleurodesis (Mean) |
|---|---|---|
| Total 12-month costs | $40,179 | $46,640 |
| Inpatient costs | $15,216 | $20,393 |
The TIME2 trial showed median hospital stay of 0 days (IQR 0-1) for IPC versus 4 days (IQR 2-6) for talc pleurodesis — a difference of 3.5 days (p<0.001). In the AMPLE pilot study, IPC patients spent 6.5 median days in hospital versus 18.0 days for talc patients (p=0.002), with the pleurodesis group spending 11.2% of remaining life in hospital versus 8.0% for IPC.[5][7][38]
The annual cost of MPE-related hospital admissions in the United States is estimated at more than $5 billion. The burden of hospital-based resource utilization associated with MPE has decreased over time, with a reduction in attributable hospitalizations by one-third over a decade, corresponding to a decrease in inpatient pleurodesis procedures.[15][49]
For mesothelioma patients, treatment costs can be covered through asbestos trust fund claims, lawsuit settlements, and VA benefits for veterans.[17][9]
What Do Current Guidelines Recommend?
| Guideline | Year | First-Line Recommendation | For Trapped Lung |
|---|---|---|---|
| BTS | 2023 | IPC or talc pleurodesis (patient choice)[6] | IPC |
| ATS/STS/STR | 2018 | Either IPC or chemical pleurodesis[35] | IPC over pleurodesis |
| ASCO | 2025 | Integrated with immunotherapy framework[50] | Per performance status |
| NCCN | 2024 | Palliative effusion management; P/D over EPP for surgery[51] | IPC for trapped lung |
The 2023 BTS guideline represents a major paradigm shift from the 2010 guidelines, which had reserved IPCs for patients who either failed pleurodesis or had trapped lung. The 2023 guideline now recommends that patients without known non-expandable lung should be offered a choice of IPC or pleurodesis as first-line intervention, with relative risks and benefits discussed to individualize treatment. Daily IPC drainage is recommended to increase pleurodesis rates when catheter removal is a priority.[6][52]
All major guidelines agree on several key points: no pleural interventions for asymptomatic patients; IPC is the treatment of choice for non-expandable lung; both IPC and bedside talc pleurodesis are first-line options for expandable lung; and shared decision-making with patients is emphasized.[44][53]
What Is the History of Pleurodesis?
| Year | Milestone |
|---|---|
| 1906 | Silver nitrate solution proposed for pleurodesis by Spengler[1] |
| 1935 | Norman Bethune published the first successful use of talc for pleural adhesions, using a Jacobeus thoracoscope[54] |
| 1958 | J.S. Chambers reported the first use of talc for palliative treatment of malignant pleural effusion[1] |
| 1990s | VATS talc poudrage became increasingly standard[55] |
| 2005 | Dresler Phase III intergroup study (n=501) comparing poudrage vs slurry[22] |
| 2006 | European 558-patient safety study confirmed zero ARDS with large-particle talc[14] |
| 2012 | TIME2 trial — first RCT comparing IPC vs talc pleurodesis[5] |
| 2014 | LENT prognostic score developed and validated[31] |
| 2017 | AMPLE trial results — IPC reduces hospital days[7] |
| 2018 | ATS/STS/STR guideline endorses IPC as first-line; IPC-PLUS trial confirms combination approach[35][8] |
| 2019 | TAPPS trial (n=330) — no difference between poudrage and slurry[12] |
| 2023 | BTS guideline shift — IPC recommended as first-choice for MPE alongside pleurodesis[6] |
| 2025 | ASCO mesothelioma guideline update — immunotherapy integration[50] |
Bethune's 1935 innovation — using iodized talc via thoracoscopic insufflation — remarkably anticipated the modern technique of talc poudrage still used nearly a century later.[54][28]
What Emerging Technologies Are Being Developed?
Several innovative approaches to MPE management are under active investigation.
Intrapleural Immunotherapy: Intrapleural injection of anti-PD1 monoclonal antibodies represents a novel approach, with preclinical data demonstrating that intrapleural anti-PD1 could control MPE by enhancing local cytotoxic T lymphocyte activity. However, a multicenter phase 2 study of single intrapleural nivolumab (40 mg) in NSCLC with pleural effusion found the approach ineffective, with 61.5% recurrence at 3 months. Multiple clinical trials are exploring intrapleural immunotherapies including oncolytic virus therapy and intrapleural CAR T-cell therapy.[56][57][58]
Precision Pleurodesis: Elastance-directed management uses pleural manometry to identify patients with non-expandable lung prior to treatment, directing them to IPC rather than pleurodesis. The Pre-EDIT feasibility trial established that PEL₂₅₀ of 14.5 cm H₂O/L or greater reliably predicts pleurodesis failure, enabling personalized treatment selection.[33][59]
Talc Foam: Preclinical research has explored talc foam as an improved delivery method. In a mouse model, talc foam achieved significantly better survival than talc slurry (21 vs 13.5 days, p<0.0001) with improved distribution across pleural surfaces.[60]
Intrapleural Fibrinolytic Therapy: The TIME3 trial randomized 71 patients with non-draining MPE between intrapleural urokinase and placebo. While radiological improvement in effusion size was observed, there was no significant difference in dyspnea scores, quality of life, or pleurodesis rates.[13][20]
Frequently Asked Questions
What is pleurodesis and why do mesothelioma patients need it?
Pleurodesis is a procedure that permanently seals the pleural space — the thin gap between the lung and chest wall — to prevent fluid from reaccumulating. The vast majority of pleural mesothelioma patients develop malignant pleural effusions that cause severe breathlessness. Without definitive treatment like pleurodesis, these effusions typically recur within 30 days of drainage, requiring repeated hospital visits and interventions.[13][9]
How successful is pleurodesis in mesothelioma compared to other cancers?
Pleurodesis is less effective in mesothelioma than in most other cancers. Studies show an overall success rate of 68.2% in mesothelioma compared to 84.4% in breast cancer and 87.8% in other tumors. The primary reason is a higher rate of trapped lung (non-expandable lung) in mesothelioma patients, where tumor encases the lung surface and prevents the pleural layers from fusing together.[4][10]
Is talc pleurodesis safe?
Yes, when graded (calibrated) large-particle talc is used. The shift from ungraded to graded talc has dramatically reduced the risk of the most serious complication — acute respiratory distress syndrome (ARDS) — to less than 1%. A major European study of 558 patients using large-particle talc reported zero cases of ARDS. Common side effects include fever and chest pain, which are generally manageable with standard medications.[14][28]
Should I choose pleurodesis or an indwelling pleural catheter (IPC)?
The choice depends on several factors. Pleurodesis is typically preferred when the lung expands fully after fluid drainage, the patient can tolerate a hospital stay of 3-7 days, and staging biopsies are needed during the procedure. An IPC is generally preferred when the lung is trapped or non-expandable, the patient prefers to minimize hospital time, the effusion has loculations, or expected survival is shorter. Current guidelines from the BTS and ATS recommend both as first-line options with shared decision-making.[6][35][11]
Can pleurodesis be performed during chemotherapy?
Yes. Pleurodesis can be performed alongside systemic therapy including chemotherapy (pemetrexed/cisplatin) and immunotherapy (nivolumab/ipilimumab). Current NCCN guidelines recommend palliative management of effusions in parallel with systemic treatment. Early referral to pleural services is recommended to enable maximum quality-of-life benefits and reduce the risk of the lung becoming trapped over time.[51][44][20]
What financial assistance is available for mesothelioma patients needing pleurodesis?
Mesothelioma patients may be eligible for multiple compensation sources to help cover treatment costs: asbestos trust funds hold over $30 billion for victims of asbestos exposure, mesothelioma lawsuits can provide substantial settlements, and veterans with service-related exposure may qualify for VA disability benefits. An experienced mesothelioma attorney can evaluate all available options.[17][9][61]
Related Pages
- Mesothelioma Surgery Overview — Overview of all surgical options for mesothelioma
- Extrapleural Pneumonectomy — Comprehensive guide to EPP surgical procedure
- Pleurectomy and Decortication — Lung-sparing surgery for pleural mesothelioma
- Mesothelioma Treatment Costs — Financial guide to treatment expenses
- Understanding Your Diagnosis — First steps after a mesothelioma diagnosis
- Mesothelioma Diagnosis and Staging — How mesothelioma is diagnosed and staged
- Asbestos Trust Funds — $30+ billion available for compensation claims
| ⚠ Statute of Limitations Warning: Filing deadlines vary by state from 1-6 years from diagnosis. Texas allows 2 years from diagnosis or discovery. Contact an attorney immediately to preserve your rights. |
|
Free, Confidential Case Evaluation Call (866) 222-9990 or visit dandell.com/contact-us No upfront fees • Experienced representation • National practice |
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Chemical pleurodesis – a review of mechanisms involved in pleural space obliteration, Respiratory Research (2019). PMC6836467.
- ↑ 2.0 2.1 Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis, PLoS ONE (2014). PMID 24475222. 20 trials, n=1,525.
- ↑ 3.0 3.1 3.2 3.3 Talc pleurodesis in malignant pleural effusion: updated meta-analysis, Lung Cancer (2021). PMID 33222091. 24 studies.
- ↑ 4.0 4.1 4.2 4.3 4.4 Efficacy of medical thoracoscopic talc pleurodesis by tumor type, Respirology (2015). PMC4694419.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Effect of an Indwelling Pleural Catheter vs Chest Tube and Talc Pleurodesis for Relieving Dyspnea in Patients With Malignant Pleural Effusion: The TIME2 Randomized Controlled Trial, JAMA (2012). PMID 22610520.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 British Thoracic Society Guideline for pleural disease, Thorax (2023).
- ↑ 7.0 7.1 7.2 7.3 Effect of an Indwelling Pleural Catheter vs Talc Pleurodesis on Hospitalization Days in Patients With Malignant Pleural Effusion: The AMPLE Randomized Clinical Trial, JAMA (2017).
- ↑ 8.0 8.1 8.2 8.3 The efficacy of indwelling pleural catheter placement versus chest tube and talc pleurodesis: IPC-PLUS trial, American Journal of Respiratory and Critical Care Medicine (2018). PMID 25880969.
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 Danziger & De Llano, Mesothelioma Attorneys
- ↑ 10.0 10.1 10.2 10.3 10.4 Mesothelioma Lawyer Center
- ↑ 11.0 11.1 11.2 11.3 Mesothelioma Treatment Options, Danziger & De Llano
- ↑ 12.0 12.1 12.2 12.3 Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate: The TAPPS Randomized Clinical Trial, JAMA (2019). PMID 31804680. n=330.
- ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 Updates in the management of malignant pleural effusion, PMC (2025). PMC12433027.
- ↑ 14.0 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 Pleurodesis with large-particle talc poudrage is safe in malignant pleural effusion, European Respiratory Journal (2007). PMC2094239. n=558.
- ↑ 15.0 15.1 15.2 15.3 15.4 Resource Use and Costs of Indwelling Pleural Catheters Versus Pleurodesis for Malignant Pleural Effusions: A Population-Based Study, Annals of the American Thoracic Society (2024).
- ↑ 16.0 16.1 Review of malignant pleural mesothelioma survival after talc pleurodesis or surgery, Journal of Thoracic Disease (2017). PMC5756994.
- ↑ 17.0 17.1 17.2 MesotheliomaAttorney.com, Legal Resources and Claim Information
- ↑ 18.0 18.1 18.2 Treatment of malignant pleural effusion, Annals of Translational Medicine (2018). PMC5994464.
- ↑ 19.0 19.1 19.2 Malignant pleural mesothelioma: update on treatment options with a focus on novel therapies, Clinical Chest Medicine (2013). PMC3612173.
- ↑ 20.0 20.1 20.2 20.3 Mesothelioma Treatment, Mesothelioma Lawyer Center
- ↑ Rapid pleurodesis is an outpatient alternative in patients with malignant pleural effusions, Journal of Thoracic Disease (2014). PMC4283316.
- ↑ 22.0 22.1 22.2 22.3 22.4 Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion, Chest (2005). PMID 15764775. n=501.
- ↑ Efficacy and safety of doxycycline versus iodopovidone for pleurodesis in MPE, Pulmonology (2023). PMID 37428348.
- ↑ Long-term results of pleurodesis in malignant pleural effusions, Turkish Journal of Thoracic and Cardiovascular Surgery (2014). PMC4162080.
- ↑ 25.0 25.1 Pleurodesis with povidone-iodine as an effective procedure in management of patients with malignant pleural effusion, Journal of Thoracic Disease (2013).
- ↑ Efficacy and Safety of Povidone-iodine Pleurodesis in Malignant Pleural Effusions, Indian Journal of Palliative Care (2017). PMC5294438.
- ↑ 27.0 27.1 Chemical Pleurodesis for Malignant Pleural Effusion: How Far Have We Come in 80 Years?, Respiration (2015).
- ↑ 28.0 28.1 28.2 28.3 Mesothelioma.net, Asbestos Information and Patient Resources
- ↑ Does mechanical pleurodesis result in better outcomes than chemical pleurodesis for recurrent primary spontaneous pneumothorax?, Interactive Cardiovascular and Thoracic Surgery (2012). PMC3290368.
- ↑ 30.0 30.1 Predictors of outcome of pleurodesis in patients with malignant pleural effusion: a systematic review and meta-analysis, Expert Review of Respiratory Medicine (2020). 34 studies, n=4,626.
- ↑ 31.0 31.1 31.2 Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score, Thorax (2014).
- ↑ 32.0 32.1 Trapped Lung, StatPearls, National Center for Biotechnology Information (2024).
- ↑ 33.0 33.1 33.2 Pleural Space Elastance and Its Relation to Success Rates of Pleurodesis, Frontiers in Medicine (2020). PMC7801813.
- ↑ Nonexpandable Lung: More Than Just a Call from Radiology, Annals of the American Thoracic Society (2019).
- ↑ 35.0 35.1 35.2 35.3 35.4 35.5 35.6 Management of Malignant Pleural Effusions: An Official ATS/STS/STR Clinical Practice Guideline, American Journal of Respiratory and Critical Care Medicine (2018).
- ↑ 36.0 36.1 Mesothelioma Treatment Options, Mesothelioma.net
- ↑ 37.0 37.1 Risk factors related to pleural empyema after talc slurry pleurodesis, Scientific Reports (2022). PMC9440271.
- ↑ 38.0 38.1 Protocol of the Australasian Malignant Pleural Effusion (AMPLE) trial, BMJ Open (2014).
- ↑ Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study (n=558), The Lancet (2007). PMID 17482984.
- ↑ 40.0 40.1 Indwelling Pleural Catheter versus Pleurodesis for Malignant Pleural Effusions: A Systematic Review and Meta-Analysis, Annals of the American Thoracic Society (2019).
- ↑ Silver Nitrate-Coated Versus Standard Indwelling Pleural Catheter for Malignant Effusions: The SWIFT Randomized Trial, Annals of the American Thoracic Society (2022).
- ↑ Medical thoracoscopy with talc poudrage and indwelling pleural catheter insertion versus medical thoracoscopy with talc poudrage alone (TACTIC), The Lancet Respiratory Medicine (2026).
- ↑ Mesothelioma Claims, MesotheliomaAttorney.com
- ↑ 44.0 44.1 44.2 44.3 Current Trends in Treating Malignant Pleural Effusion: Evidence, Guidelines, and Best Practice Recommendations, JCO Oncology Practice (2024).
- ↑ 45.0 45.1 Australasian Malignant Pleural Effusion (AMPLE)-3 trial protocol, Trials (2022). PMC9235203.
- ↑ Quality of life in patients with malignant pleural effusion, Pleura and Peritoneum (2022). PMC9214818.
- ↑ Talc pleurodesis versus indwelling pleural catheter among patients with malignant pleural effusion: a meta-analysis of randomized controlled trials, World Journal of Surgical Oncology (2020).
- ↑ Analysis of Quality of Life after Pleurodesis in Patients with Malignant Pleural Effusion, Respiration (2019).
- ↑ Healthcare Costs and Utilization among Patients Hospitalized for Malignant Pleural Effusion, Annals of the American Thoracic Society (2020). PMID 32155630.
- ↑ 50.0 50.1 Treatment of Pleural Mesothelioma: ASCO Guideline Update, Journal of Clinical Oncology (2025).
- ↑ 51.0 51.1 NCCN Guidelines Insights: Mesothelioma: Pleural, Version 1.2024, Journal of the National Comprehensive Cancer Network (2024). PMID 38503043.
- ↑ Updates on British Thoracic Society Statement on Pleural Disease, Current Pulmonology Reports (2024). PMC11037506.
- ↑ Management of Malignant Pleural Effusion in 2024: A Definitive and Comprehensive Review, JCO Oncology Practice (2024).
- ↑ 54.0 54.1 The medical life of Henry Norman Bethune, Canadian Medical Association Journal (2015). PMC4676399.
- ↑ Prospective randomized trial of talc slurry vs bleomycin in pleurodesis for symptomatic malignant pleural effusions, Chest (1997). PMID 9266880.
- ↑ Intrapleural Injection of Anti-PD1 Antibody: A Novel Management for Malignant Pleural Effusion, Frontiers in Immunology (2021). PMC8711587.
- ↑ Multicenter phase 2 study of intrapleural nivolumab in patients with NSCLC and pleural effusion, Journal of Thoracic Oncology (2023). PMC10077040.
- ↑ Intrapleural immunotherapy: An update on emerging treatment strategies for pleural malignancy, Clinical Respiratory Journal (2020).
- ↑ Pre-EDIT: protocol for a randomised feasibility trial of elastance-directed intrapleural catheter or talc pleurodesis, BMJ Open Respiratory Research (2018).
- ↑ An improved method of delivering a sclerosing agent for the treatment of malignant pleural effusion, Scientific Reports (2019). PMC6589887.
- ↑ Mesothelioma Lawyers Near Me, Find Experienced Mesothelioma Attorneys