Pleural Effusion, Malignant Clinical Trial
Official title:
Pre-EDIT: A Randomised, Feasibility Trial of Elastance-Directed Intra-pleural Catheter or Talc Pleurodesis (EDIT) in the Management of Symptomatic Malignant Pleural Effusion Without Obvious Non-expansile Lung
Malignant Pleural Effusion (MPE) is a collection of fluid inside the chest caused by cancer.
It is a common medical problem and often causes severe breathlessness. Patients with this
condition generally have a very poor survival and so it is extremely important that they are
given effective treatment as soon as possible to minimise the amount of time they have to
spend in hospital.
Standard treatment for MPE involves an admission to hospital to drain the fluid and then
attempt to prevent the fluid from returning by sticking the lung to the inside of the rib
cage with medical talc powder which acts like glue. This is called talc pleurodesis (TP) but
unfortunately it fails in about 30% of patients. This is usually because the lung has not
fully re-expanded and has not made contact with the inside of the ribs. When this happens,
the fluid can be effectively treated with a different type of drainage tube called an
indwelling pleural catheter (IPC) which tunnels under the skin and is drained at home by the
district nurses.
It is thought that pressure measurements taken from the fluid as it is drained may be able to
show doctors whether or not the lung will re-expand before patients are committed to either
TP or an IPC. In this research we wish to test if these measurements can be used to choose
which is the best first treatment option (TP or IPC) for patients with MPE. We have called
this 'EDIT management'. Since it is uncertain whether this new approach will work, patients
will be randomised to have either standard treatment or EDIT management. We will compare the
two groups to assess whether the patients who had EDIT management had to have fewer repeat
procedures over the following 3 months.
n/a
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