Standard Chest Tube Compared With a Small Catheter in Treating Malignant Pleural Effusion in Patients With Cancer

NCT ID: NCT00042770

Last Updated: 2016-07-04

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 67 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2002-05-31
• Study Completion Date: 2008-02-29

Brief Summary

RATIONALE: It is not yet known whether pleurodesis using a chest tube with infusions of talc is more effective in improving quality of life than pleurodesis using a small catheter in treating malignant pleural effusion.

PURPOSE: Randomized phase III trial to compare the effectiveness of a chest tube and talc with that of a small catheter in treating malignant pleural effusion in patients who have cancer.

Detailed Description

OBJECTIVES:

• Compare the success rate in patients with cancer who undergo pleurodesis using a standard chest tube with talc slurry vs a small (PleurX) catheter for the treatment of a symptomatic unilateral malignant pleural effusion.
• Compare the 30-day effusion control rate in patients treated with these procedures.
• Compare quality of life in these patients at 7-14 and 30-37 days after treatment with these procedures.
• Compare patient acceptance and satisfaction after treatment with these procedures.
• Compare the level of symptoms and dyspnea experienced by patients treated with these procedures.
• Compare the types, causes, and rates of early technical failures of these procedures in these patients.
• Compare the 30-day effusion recurrences in patients treated with these procedures.
• Compare the 60-day durability of pleurodesis in patients treated with these procedures.
• Compare the mortality, morbidity, and common surgical complications in patients treated with these procedures.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to inpatient status (yes vs no), disease type (breast vs lung vs other), and concurrent systemic chemotherapy (yes vs no). Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients undergo placement of a standard pleural chest tube. Within 36 hours of chest tube placement, patients undergo pleurodesis comprising intrapleural administration of talc slurry once followed by clamping of the chest tube for 2 hours while different patient positions are used to distribute the talc. The chest tube is then unclamped to allow continuous drainage. When the chest tube drainage is less than 150 mL over 24 hours, pleurodesis is assumed and the chest tube is removed.
• Arm II: Patients undergo pleurodesis comprising placement of a small (PleurX) catheter followed by pleural drainage for up to 90 minutes once daily. When the catheter drainage is less than 30 mL per day for 3 consecutive days, pleurodesis is assumed and the catheter is removed.

Quality of life and dyspnea are assessed at baseline and then at 7-14 and 30-37 days after treatment.

Patients are followed at 30 and 60 days.

Conditions

Metastatic Cancer; Pulmonary Complications

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Arm I

Patients undergo placement of a standard pleural chest tube. Within 36 hours of chest tube placement, patients undergo pleurodesis comprising intrapleural administration of talc slurry once followed by clamping of the chest tube for 2 hours while different patient positions are used to distribute the talc. The chest tube is then unclamped to allow continuous drainage. When the chest tube drainage is less than 150 mL over 24 hours, pleurodesis is assumed and the chest tube is removed.

Group Type: ACTIVE_COMPARATOR

talc

Intervention Type: OTHER

Given intrapleurally

Arm II

Patients undergo pleurodesis comprising placement of a small (PleurX) catheter followed by pleural drainage for up to 90 minutes once daily. When the catheter drainage is less than 30 mL per day for 3 consecutive days, pleurodesis is assumed and the catheter is removed.

Group Type: EXPERIMENTAL

dyspnea management

Intervention Type: PROCEDURE

No talc

Interventions

talc

Given intrapleurally

Intervention Type: OTHER

dyspnea management

No talc

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• No bilateral effusions by plain chest x-ray
• Histologically or cytologically confirmed solid tumor or hematologic malignancy

• Histologic confirmation of malignant cells in pleural fluid is not required
• Pleural spaces must be naive to pleurodesis attempts

• No prior intrapleural therapy (defined as a chest tube in place or placed to drain an effusion, prior surgical pleurectomy, or any prior chemical or mechanical pleurodesis on the ipsilateral side)

• Placement of a small interventional radiology catheter for temporary drainage is not considered intrapleural therapy as long as no sclerosant medication was given and it has not been in place longer than 10 days

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• CTC 0-2

Hematopoietic

• Granulocyte count at least 1,500/mm^3
• Platelet count at least 100,000/mm^3

Pulmonary

• No active pleural infection

Other

• No allergy to talc
• No surgical contraindication to talc usage
• Not pregnant or nursing
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Chemotherapy

• Concurrent systemic chemotherapy allowed

Radiotherapy

• Concurrent palliative radiotherapy to a symptomatic lesion allowed except to the treated hemithorax within 30 days of the drainage procedure

Surgery

• See Disease Characteristics
• Prior thoracotomies without specific pleural ablation (including lobectomy but not pneumonectomy) allowed
• Prior needle-based diagnostic interventions (fine-needle aspiration, small bore catheter drainage of less than 10 days, or thoracentesis) allowed

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Cancer Institute (NCI)

NIH

Sponsor Role: collaborator

Alliance for Clinical Trials in Oncology

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Todd Demmy, MD

Role: STUDY_CHAIR

Roswell Park Cancer Institute

Locations

Providence Saint Joseph Medical Center - Burbank

Burbank, California, United States

Countries

United States

Other Identifiers

U10CA076001

Identifier Type: NIH

Identifier Source: secondary_id

View Link

CALGB-30102

Identifier Type: -

Identifier Source: secondary_id

CDR0000069451

Identifier Type: REGISTRY

Identifier Source: secondary_id

CALGB-30102

Identifier Type: -

Identifier Source: org_study_id