Tunnelled pleural catheters in malignant pleural effusion – Author's reply

In fact, the lack of a negative effect of tunnelled pleural catheter treatment on survival has been well documented in a randomised controlled trial in which the technique was compared with doxycycline pleurodesis: survival rates were identical between the two groups.3 I declare that I have no conflict of interest. [...] it has been suggested that, since malignant pleural mesothelioma is pauci vascular, effective pleurodesis could deprive this neoplasm of important pleural fluid nutrients.2 And fourth, talc could function as a specific tumour suppressant.3 Permanent suppression of the effusion and talc tumour suppression could explain why talc poudrage-which is more effective than most pleural sclerosants-might be associated with longer survival in malignant pleural mesothelioma.4 Tremblay's reference 3 shows that a relatively inferior form of pleurodesisdoxycycline instillation-was associated with the same survival as the tunnelled catheter.