It is well-known, that patients with diagnosis "mesothelioma" suffer from permanent and troublesome dyspnea due to profuse pleural effusions repeatedly accumulating. For dyspnea relief it is recommended to use an acceptable procedure. It consists of two stages. In the first stage, using tube thoracostomy or video thoracoscopy, the pleural space should be totally evacuated from the pleural effusion. In the second stage it is to introduce a sclerosing agent into the pleural space, making an injection or insufflation.
All these measures are intended for provoking an inflammatory reaction of the parietal and visceral pleural surface that will promote obliteration of the pleural space (namely pleurodesis). This ensured that pleural liquid cannot be repeatedly accumulated. It should be taken into account that before performing pleurodesis it is required to make total drainage and absolute re-expansion of the lung.
The most often treatment for recurrent malignant effusions, including lung cancer patients and metastatic ovarian or breast cancer, is pleurodesis or pleural sclerosis.
Due to the limited expected life length, this therapy is aimed at palliating the symptoms, or to reduce the discomfort the patient suffers, to lower the length of stay in hospital and its total costs.
The pleural symphysis, such as tetracycline, minocycline, quinacrine, and bleomycin, used to be reached through usage of multiple compounds. Sterile talc (either as a powder or as slurry) is now the most used compound for pleurodesis and it proved to be the most effective one. Talc pleurodesis is, unfortunately, often unsuccessful in mesothelioma treatment due to the fact that the lung gets "trapped" because of a vast tumor that covers the pleural cavity.
The procedures of pleurectomy or decortication are required in these cases, but only if the patient is strong enough to face them. The recurrence of pleural effusion in mesothelioma is better fought by pleurectomy than by talc pleurodesis, but unfortunately the first means causes higher morbidity. EPP, despite its aggressive approach, is an effective palliative treatment for profound dyspnea and orthopnea which are associated with considerable ventilation-perfusion mismatch that let the tumor encase the lung.
Advanced malignant mesothelioma is treated by Pleurodesis. This is the symptomatic treatment that includes components like drainage of effusions, chest tube pleurodesis, or thoracoscopic pleurodesis.
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