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Current Pulmonology Reports
Published in: Current Pulmonology Reports 2/2012

01-06-2012 | Pleural Diseases and Mesothelioma (YCG Lee, Section Editor)

Management of malignant pleural effusions

Authors: David Hsia, Ali I. Musani

Published in: Current Pulmonology Reports | Issue 2/2012

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Abstract

Malignant pleural effusions (MPE) are a common occurrence in many advanced malignancies. They are a significant cause of morbidity and mortality; symptoms can be debilitating to patients and impair quality of life, especially as many of these patients are already functionally impaired by their underlying cancer and medical treatment. MPE generally represent advanced stage malignancy and the primary goal of therapy is palliation of symptoms. The purpose of this article is to review the therapeutic options available in the treatment of MPE and discuss clinical factors affecting management decision-making.
Literature
1.
Neragi-Miandoab S. Malignant pleural effusion, current and evolving approaches for its diagnosis and management. Lung Cancer. 2006;54:1–9.PubMedCrossRef
2.
American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med. 2000;162:1987–2001.
3.
Chernow B, Sahn SA. Carcinomatous involvement of the pleura: an analysis of 96 patients. Am J Med. 1977;63:695–702.PubMedCrossRef
4.
Abbruzzese JL, Abbruzzese MC, Hess KR, et al. Unknown primary carcinoma: natural history and prognostic factors in 657 consecutive patients. J Clin Oncol. 1994;12:1272–80.PubMed
5.
van de Molengraft FJ, Vooijs GP. Survival of patients with malignancy-associated effusions. Acta Cytol. 1989;33:911–6.PubMed
6.
Sears D, Hajdu SI. The cytologic diagnosis of malignant neoplasms in pleural and peritoneal effusions. Acta Cytol. 1987;31:85–97.PubMed
7.
Bonnefoi H, Smith IE. How should cancer presenting as a malignant pleural effusion be managed? Br J Cancer. 1996;74:832–5.PubMedCrossRef
8.
Kolschmann S, Ballin A, Gillissen A. Clinical efficacy and safety of thoracoscopic talc pleurodesis in malignant pleural effusions. Chest. 2005;128:1431–5.PubMedCrossRef
9.
Musani AI, Haas AR, Seijo L, et al. Outpatient management of malignant pleural effusions with small-bore, tunneled pleural catheters. Respiration. 2004;71:559–66.PubMedCrossRef
10.
Putnam Jr JB, Walsh GL, Swisher SG, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg. 2000;69:369–75.PubMedCrossRef
11.
12.
13.
•• Roberts ME, Neville E, Berrisford RG, et al. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. British Thoracic Society guidelines on the management of malignant pleural effusions. Provides review of data and graded strength of recommendations.
14.
Porcel JM, Alvarez M, Salud A, et al. Should a cytologic study be ordered in transudative pleural effusions? Chest. 1999;116:1836–7.PubMedCrossRef
15.
Ashchi M, Golish J, Eng P, et al. Transudative malignant pleural effusions: prevalence and mechanisms. South Med J. 1998;91:23–6.PubMedCrossRef
16.
Khaleeq G, Musani AI. Emerging paradigms in the management of malignant pleural effusions. Respir Med. 2008;102:939–48.PubMedCrossRef
17.
18.
19.
Yano S, Shinohara H, Herbst RS, et al. Production of experimental malignant pleural effusions is dependent on invasion of the pleura and expression of vascular endothelial growth factor/vascular permeability factor by human lung cancer cells. Am J Pathol. 2000;157:1893–903.PubMedCrossRef
20.
Yano S, Herbst RS, Shinohara H, et al. Treatment for malignant pleural effusion of human lung adenocarcinoma by inhibition of vascular endothelial growth factor receptor tyrosine kinase phosphorylation. Clin Cancer Res. 2000;6:957–65.PubMed
21.
Light RW, Hamm H. Malignant pleural effusion: would the real cause please stand up? Eur Respir J. 1997;10:1701–2.PubMedCrossRef
22.
Martinez-Moragon E, Aparicio J, Sanchis J, et al. Malignant pleural effusion: prognostic factors for survival and response to chemical pleurodesis in a series of 120 cases. Respiration. 1998;65:108–13.PubMedCrossRef
23.
Hausheer FH, Yarbro JW. Diagnosis and treatment of malignant pleural effusion. Semin Oncol. 1985;12:54–75.PubMed
24.
Adler RH, Sayek I. Treatment of malignant pleural effusion: a method using tube thoracosctomy and talc. Ann Thorac Surg. 1976;22:8–15.PubMedCrossRef
25.
Villanueva AG, Gray Jr AW, Shahian DM, et al. Efficacy of short term versus long term tube thoracostomy drainage before tetracycline pleurodesis in the treatment of malignant pleural effusions. Thorax. 1994;49:23–5.PubMedCrossRef
26.
Feller-Kopman D, Berkowitz D, Boiselle P, et al. Large-volume thoracentesis and the risk of reexpansion pulmonary edema. Ann Thorac Surg. 2007;84:1656–61.PubMedCrossRef
27.
28.
Tarver RD, Broderick LS, Conces Jr DJ. Reexpansion pulmonary edema. J Thorac Imaging. 1996;11:198–209.PubMed
29.
Antony VB, Loddenkemper R, Astoul P, et al. Management of malignant pleural effusions. Eur Respir J. 2001;18:402–19.PubMedCrossRef
30.
Sorenson PG, Svendsen TL, Enk B. Treatment of malignant pleural effusion with drainage, with and without instillation of talc. Eur J Respir Dis. 1984;65:131–5.
31.
Groth G, Gatzemeier U, Haussingen K, et al. Intrapleural palliative treatment of malignant pleural effusions with mitoxantrone versus placebo (pleural tube alone). Ann Oncol. 1991;2:213–5.PubMed
32.
Stather DR, Tremblay A. Use of tunneled pleural catheters for outpatient treatment of malignant pleural effusions. Curr Opin Pulmon Med. 2007;13:328–33.CrossRef
33.
MacEachern P, Stather DR, Tremblay A. Tunneled pleural catheters. In: Beamis JFJ, Mathur P, Mehta A, editors. Interventional pulmonary medicine. New York: Informa Healthcare; 2009.
34.
Van den Toorn LM, Schaap E, Surmont VF, et al. Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter. Lung Cancer. 2005;50:123–7.PubMedCrossRef
35.
Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest. 2006;129:362–8.PubMedCrossRef
36.
• Van Meter ME, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med. 2011;26:70–76. Meta-analysis of 19 studies investigating tunneled pleural catheters. PubMedCrossRef
37.
Qureshi RA, Collinson SL, Powell RJ, et al. Management of malignant pleural effusion associated with trapped lung syndrome. Asian Cardiovasc Thorac Ann. 2008;16:120–3.PubMed
38.
• Efthymiou CA, Masudi T, Thorpe JA, et al. Malignant pleural effusion in the presence of trapped lung. Five-year experience of PleurX tunneled catheters. Interact Cardiovasc Thorac Surg. 2009;9:961–964. Description of treatment of trapped lung by tunneled pleural catheter drainage. PubMedCrossRef
39.
Sioris T, Sihvo E, Salo J, et al. Long-term indwelling pleural catheter (PleurX) for malignant pleural effusion unsuitable for talc pleurodesis. Eur J Surg Oncol. 2009;35:546–51.PubMedCrossRef
40.
Tremblay A, Mason C, Michaud G. Use of tunneled catheters for malignant pleural effusions in patients fit for pleurodesis. Eur Respir J. 2007;30:759–62.PubMedCrossRef
41.
Putnam Jr JB, Light RW, Rodriguez RM, et al. A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions. Cancer. 1999;86:1992–9.PubMedCrossRef
42.
• Olden AM, Holloway R. Treatment of malignant pleural effusion: PleuRx catheter or talc pleurodesis? A cost-effectiveness analysis. J Palliat Med. 2010;13:59–65. Cost-benefit analysis of tunneled pleural catheter versus pleurodesis treatment modalities. PubMedCrossRef
43.
Reich H, Beattie EJ, Harvey JC. Pleuroperitoneal shunt for malignant pleural effusions: a one-year experience. Semin Surg Oncol. 1993;9:160–2.PubMedCrossRef
44.
Lee KA, Harvey JC, Reich H, et al. Management of malignant pleural effusions with pleuroperitoneal shunting. J Am Coll Surg. 1994;178:586–8.PubMed
45.
46.
Clementsen P, Evald T, Grode G, et al. Treatment of malignant pleural effusion: pleurodesis using a small percutaneous catheter. A prospective randomized study. Respir Med. 1998;92:593–6.PubMedCrossRef
47.
Goff BA, Mueller PR, Muntz HG, et al. Small chest-tube drainage followed by bleomycin sclerosis for malignant pleural effusions. Obstet Gynecol. 1993;81:993–6.PubMed
48.
Chen YM, Shih JF, Yang KY, et al. Usefulness of pig-tail catheter for palliative drainage of malignant pleural effusions in cancer patients. Support Care Canc. 2000;8:423–6.CrossRef
49.
Spiegler PA, Hurewitz AN, Groth ML. Rapid pleurodesis for malignant pleural effusions. Chest. 2003;23:1895–8.CrossRef
50.
Parulekar W, Di Primio G, Matzinger F, et al. Use of small-bore vs. large-bore hest tubes for treatment of malignant pleural effusions. Chest. 2001;120:19–25.PubMedCrossRef
51.
Caglayan B, Torun E, Turan D, et al. Efficacy of iodopovidone pleurodesis and comparison of small-bore catheter versus large bore chest tube. Ann Surg Oncol. 2008;15:2594–9.PubMedCrossRef
52.
Dryzer SR, Allen ML, Strange C, et al. A comparison of rotation and nonrotation in tetracycline pleurodesis. Chest. 1993;104:1763–9.PubMedCrossRef
53.
Mager HJ, Maesen B, Verzijlbergen F, et al. Distribution of talc suspension during treatment of malignant pleural effusion with talc pleurodesis. Lung Cancer. 2002;36:77–81.PubMedCrossRef
54.
Tassi GF, Davies RJO, Noppen M. Advanced techniques in medical thoracoscopy. Eur Respir J. 2006;28:1051–9.PubMedCrossRef
55.
•Lee P, Mathur PN, Colt HG. Advances in Thoracoscopy: 100 years since Jacobaeus. Respiration. 2010;79:177–186. Review detailing the equipment, procedure, and considerations involved with medical thoracoscopy. PubMedCrossRef
56.
Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med. 1991;114:271–6.PubMed
57.
58.
Zahid I, Sharif S, Routledge T, et al. Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma? Interact Cardiovasc Thorac Surg. 2011;12:812–7.PubMedCrossRef
59.
• Treasure T, Lang-Lazdunski L, Waller D, et al. Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet Oncol. 2011;12:763–772. Large trial investigating the use of pneumonectomy in the treatment of mesothelioma. PubMedCrossRef
60.
Tan C, Sedrakyan A, Browne J, et al. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardiothor Surg. 2006;29:829–38.CrossRef
61.
Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev. 2004; (1):CD002916.
62.
Ferrer J, Montes JF, Villarino MA, et al. Influence of particle size on extrapleural talc dissemination after talc slurry pleurodesis. Chest. 2002;122:1018–27.PubMedCrossRef
63.
Paschoalini MDS, Vargas FS. Marchi et al. Prospective randomized trial of silver nitrate vs. talc slurry in pleurodesis for symptomatic malignant pleural effusions. Chest. 2005;128:684–9.CrossRef
64.
Zimmer PW, Hill M, Casey K, et al. Prospective randomized trial of talc slurry vs bleomycin for symptomatic malignant pleural effusions. Chest. 1997;112:430–4.PubMedCrossRef
65.
Walker-Renard P, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med. 1994;120:56–64.PubMed
66.
Patz EF, McAdams HP, Erasmus JJ, et al. Sclerotherapy for malignant pleural effusions: a prospective randomized trial of bleomycin vs doxycycline with small-bore catheter drainage. Chest. 1998;113:1305–11.PubMedCrossRef
67.
Heffner JE, Standerfer RJ, Torstveit J, et al. Clinical efficacy of doxycycline for pleurodesis. Chest. 1994;105:1743–7.PubMedCrossRef
68.
Pulsiripunya C, Youngchaiyud P, Puspakorn R, et al. The efficacy of doxycycline as a pleural sclerosing agent in malignant pleural effusion: a prospective study. Respirology. 1996;1:69–72.PubMedCrossRef
69.
Ong KC, Indumathi V, Raghuram J, et al. A comparative study of pleurodesis using talc slurry and bleomycin in the management of malignant pleural effusions. Respirology. 2000;5:99–103.PubMedCrossRef
70.
Dresler CM, Olak J, Herndon 2nd JE, et al. Phase 3 intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest. 2005;127:909–15.PubMedCrossRef
71.
Manes N, Rodriguez-Panadero F, Bravo J, et al. Talc pleurodesis. Prospective and randomized study clinical follow up. Chest. 2000;118:131S.
72.
Stefani A, Natali P, Casali C, et al. Talc poudrage versus talc slurry in the treatment of malignant pleural effusion. A prospective comparative study. Eur J Cardiothorac Surg. 2006;30:827–32.PubMedCrossRef
73.
Yim AP, Chan AT, Lee TW, et al. Thoracoscopic talc insufflations versus talc slurry for symptomatic malignant pleural effusion. Ann Thorac Surg. 1996;62:1655–8.PubMedCrossRef
74.
Heffner JE, Nietert PJ, Barbieri C. Pleural fluid pH as a predictor of pleurodesis failure: analysis of primary data. Chest. 2000;117:87–95.PubMedCrossRef
75.
Yildirim H, Metintas M, Guntulu Ak, et al. Predictors of talc pleurodesis outcome in patients with malignant pleural effusions. Lung Cancer. 2008;62:139–44.PubMedCrossRef
76.
Sahn SA. Pleurodesis for malignant and nonmalignant pleural effusions. Clin Pulm Med. 1999;6:141–6.CrossRef
77.
Aydogmus U, Ozdemir S, Cansever L, et al. Bedside talc pleurodesis for malignant pleural effusion: factors affecting success. Ann Surg Oncol. 2009;16:745–50.PubMedCrossRef
78.
Guo H, Wan Y, Tian G, et al. EGFR mutations predict a favorable outcome for malignant pleural efusión of lung adenocarcinoma with Tarceva therapy. Oncol Rep. 2011; [epub ahead of print on November 23, 2011]
79.
Janssen JP, Collier G, Astoul P, et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet. 2007;369:1535–9.PubMedCrossRef
80.
Davies CW, Traill ZC, Gleeson FV, et al. Intrapleural streptokinase in the management of malignant multiloculated pleural effusions. Chest. 1999;115:729–33.PubMedCrossRef
81.
Hsu LH, Soong TC, Feng AC, et al. Intrapleural urokinase for the treatment of loculated malignant pleural effusiosn and trapped lungs in medically inoperable cancer patients. J Thorac Oncol. 2006;1:460–7.PubMedCrossRef
82.
Okur E, Baysungur V, Tezel C, et al. Asian Cardiovasc Thorac Ann. 2011;19:238–43.PubMed
83.
Reddy C, Ernst A, Lamb C, et al. Rapid pleurodesis for malignant pleural effusions. Chest. 2011;139:1419–23.PubMedCrossRef
84.
Kriegel I, Daniel C, Falcou MC, et al. Use of a subcutaneous implantable pleural port in the management of recurrent malignant pleurisy: five-year experience based on 168 subcutaneous implantable pleural ports. J Palliat Med. 2011;14:829–34.PubMedCrossRef
85.
Perng RP, Chen YM, Wu MF, et al. Phase II trial of intrapleural paclitaxel injection for non-small-cell lung cancer patients with malignant pleural effusions. Respir Med. 1998;92:473–9.PubMedCrossRef
86.
Lombardi G, Nicoletto MO, Gusella M, et al. Intrapleural paclitaxel for malignant pleural effusion from ovarian and breast cancer: a phase II study with pharmacokinetic analysis. Cancer Chemother Pharmacol. Epub ahead of print 2011, Oct 29.
87.
Lerza R, Vannozzi MO, Tolino G, et al. Carboplatin and cisplatin pharmacokinetics after intrapleural combination treatment in patients with malignant pleural effusion. Ann Oncol. 1997;385-391.
88.
Thoda Y, Iwanaga T, Takada M, et al. Intrapleural administration of cisplatin and etoposide to treat malignant pleural effusions in patients with non-small cell lung cancer. Chemotherapy. 1999;45:197–204.CrossRef
89.
Shoji T, Tanaka F, Yanagihara K, et al. Phase II study of repeated intrapleural chemotherapy using implantable access system for management of malignant pleural effusion. Chest. 2002;121:821–4.PubMedCrossRef
90.
Ichinose Y, Tsuchiya R, Koike T. A prematurely terminated phase III trial of intraoperative intrapleural hypotonic cisplatin treatment in patients with resected non-small cell lung cancer with positive pleural lavage cytology: the incidence of carcinomatous pleuritis after surgical intervention. J Thorac Cardiovasc Surg. 2002;123:695–9.PubMedCrossRef
91.
Jones DR, Taylor MD, Petroni GR, et al. Phase I trial of intrapleural docetaxel through an implantable catheter in subjects with a malignant pleural effusion. J Thorac Oncol. 2010;5:75–81.PubMedCrossRef
92.
Ren S, Terman DS, Bohach G, et al. Intrapleural staphylococcal superantigen induces resolution of malignant pleural effusions and a survival benefit in non-small cell lung cancer. Chest. 2004;126:1529–39.PubMedCrossRef
Metadata
Title
Management of malignant pleural effusions
Authors
David Hsia
Ali I. Musani
Publication date
01-06-2012
Publisher
Current Science Inc.
Published in
Current Pulmonology Reports / Issue 2/2012
Electronic ISSN: 2199-2428
DOI
https://doi.org/10.1007/s13665-012-0012-2

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