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Outpatient Talc Administration by Indwelling Pleural Catheter for Malignant Effusion.
Bhatnagar, Rahul; Keenan, Emma K; Morley, Anna J; Kahan, Brennan C; Stanton, Andrew E; Haris, Mohammed; Harrison, Richard N; Mustafa, Rehan A; Bishop, Lesley J; Ahmed, Liju; West, Alex; Holme, Jayne; Evison, Matthew; Munavvar, Mohammed; Sivasothy, Pasupathy; Herre, Jurgen; Cooper, David; Roberts, Mark; Guhan, Anur; Hooper, Clare; Walters, James; Saba, Tarek S; Chakrabarti, Biswajit; Gunatilake, Samal; Psallidas, Ioannis; Walker, Steven P; Bibby, Anna C; Smith, Sarah; Stadon, Louise J; Zahan-Evans, Natalie J; Lee, Y C Gary; Harvey, John E; Rahman, Najib M; Miller, Robert F; Maskell, Nick A.
Afiliação
  • Bhatnagar R; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Keenan EK; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Morley AJ; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Kahan BC; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Stanton AE; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Haris M; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Harrison RN; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Mustafa RA; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Bishop LJ; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Ahmed L; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • West A; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Holme J; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Evison M; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Munavvar M; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Sivasothy P; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Herre J; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Cooper D; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Roberts M; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Guhan A; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Hooper C; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Walters J; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Saba TS; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Chakrabarti B; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Gunatilake S; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Psallidas I; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Walker SP; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Bibby AC; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Smith S; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Stadon LJ; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Zahan-Evans NJ; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Lee YCG; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Harvey JE; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Rahman NM; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Miller RF; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
  • Maskell NA; From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St.
N Engl J Med ; 378(14): 1313-1322, 2018 04 05.
Article em En | MEDLINE | ID: mdl-29617585
BACKGROUND: Malignant pleural effusion affects more than 750,000 persons each year across Europe and the United States. Pleurodesis with the administration of talc in hospitalized patients is the most common treatment, but indwelling pleural catheters placed for drainage offer an ambulatory alternative. We examined whether talc administered through an indwelling pleural catheter was more effective at inducing pleurodesis than the use of an indwelling pleural catheter alone. METHODS: Over a period of 4 years, we recruited patients with malignant pleural effusion at 18 centers in the United Kingdom. After the insertion of an indwelling pleural catheter, patients underwent drainage regularly on an outpatient basis. If there was no evidence of substantial lung entrapment (nonexpandable lung, in which lung expansion and pleural apposition are not possible because of visceral fibrosis or bronchial obstruction) at 10 days, patients were randomly assigned to receive either 4 g of talc slurry or placebo through the indwelling pleural catheter on an outpatient basis. Talc or placebo was administered on a single-blind basis. Follow-up lasted for 70 days. The primary outcome was successful pleurodesis at day 35 after randomization. RESULTS: The target of 154 patients undergoing randomization was reached after 584 patients were approached. At day 35, a total of 30 of 69 patients (43%) in the talc group had successful pleurodesis, as compared with 16 of 70 (23%) in the placebo group (hazard ratio, 2.20; 95% confidence interval, 1.23 to 3.92; P=0.008). No significant between-group differences in effusion size and complexity, number of inpatient days, mortality, or number of adverse events were identified. No significant excess of blockages of the indwelling pleural catheter was noted in the talc group. CONCLUSIONS: Among patients without substantial lung entrapment, the outpatient administration of talc through an indwelling pleural catheter for the treatment of malignant pleural effusion resulted in a significantly higher chance of pleurodesis at 35 days than an indwelling catheter alone, with no deleterious effects. (Funded by Becton Dickinson; EudraCT number, 2012-000599-40 .).
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Talco / Derrame Pleural Maligno / Pleurodese Tipo de estudo: Clinical_trials Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: N Engl J Med Ano de publicação: 2018 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Talco / Derrame Pleural Maligno / Pleurodese Tipo de estudo: Clinical_trials Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: N Engl J Med Ano de publicação: 2018 Tipo de documento: Article