The use of minimally invasive surgery (MIS) has expanded in the diagnosis and treatment of benign surgical disease. However, it's role in the treatment of cancer needs to be evaluated by scientific comparison to traditional surgery. Evaluation is critical as MIS looms as a potential standard of care for cancer therapy at the community hospital level. The Thoracic Surgery Cadre of the Cancer and Leukemia Group B (CALGB), working in close association with the Southwest Oncology Group (SWOG), the Radiation Therapy Oncology Group (RTOG), the Eastern Cooperative Oncology Group (EC)G), the North Central Cancer Treatment Group (NCCTG), and Memorial Sloan-Kettering Cancer Center (MSKCC) propose a phase III protocol to evaluate the role of MIS in cancer therapy. The major hypothesis of this proposal is the MIS in the treatment of thoracic malignancies offers a less morbid and cost effective alternative with comparable or improved results over conventional standards of care. Proposal: Malignant pleural effusions are a debilitating complication of advanced cancer. Several small reports have suggested early thoracoscopy and talc poudrage may be superior to bedside tube thoracostomy and pleurodesis in terms of pain, lung re-expansion, and duration of drainage. We propose a randomized phase III trial of thoracoscopic insufflation of talc versus talc pleurodesis via chest tube at the bedside.
Specific aims will be to compare: 1) the rate of successful pleurodesis, 2) length of drainage, 3) morbidity, 4) pain, and 5) cost of each arm.
