Management of Malignant Pleural Effusions

doi:10.1164/ajrccm.162.5.ats8-00

Cited by 445 publications

(100 citation statements)

References 174 publications

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“…However, the sensitivity of cytological diagnosis for MPE using thoracentesis is relatively poor, with an accuracy of only 62%, and the primary lesion of MPE is often difficult to identify histologically, even in cytologically positive samples 3. Moreover, half of the patients with MPE are asymptomatic and, therefore, do not undergo any procedures or treatments 4. In an era of molecular targeted agents and diverse cancer treatment managements, more accurate diagnosis and/or identification of the cancer origin is required to allow patients to be treated adequately.…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of unknown primary cancers with malignant pleural effusion at initial diagnosis

et al. 2015

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BackgroundMalignant pleural effusion (MPE) can occur during the progression of various cancers. However, factors, such as the incidence of MPE associated with different types of cancers and its potential for diagnosing previously undetected cancers, are unknown. Moreover, MPE may accompany potentially curable cancers or those with a favorable survival prognosis with adequate treatment. The present study determined the types of cancers accompanied by MPE at initial diagnosis and investigated appropriate related methods for diagnosing previously unknown cancers.MethodsWe retrospectively reviewed the medical records of 35 patients with MPE at initial cancer diagnosis between 2004 and 2012. We evaluated the patient characteristics, final diagnosis, and diagnostic processes.ResultsOf the 35 patients, 10 had lung cancer, seven ovarian or peritoneal cancer, four malignant pleural mesothelioma, one breast cancer, one lymphoma, one pancreatic cancer, and 11 had cancers of unknown origin. Diagnoses of the primary lesions were confirmed using the MPE cellblock method for seven of 11 patients (63.6%), by excisional biopsy or aspiration from other sites in four of nine patients, by exploratory laparotomy in two of three patients, and by peritoneal washing cytology in five patients.ConclusionLung cancer and cancer of unknown origin are major causes of MPE at initial presentation. However, these groups also contain cancers that are curable and those with good long‐term prognosis. The MPE cellblock method represents an accurate method for identifying cancer origin.

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Section: Introductionmentioning

confidence: 99%

Retrospective analysis of unknown primary cancers with malignant pleural effusion at initial diagnosis

et al. 2015

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“…Steger et al showed that survival rate was negatively influenced by a preoperative KPS index of less than 60% 24. The American Thoracic Society demonstrated that ECOG PS 2–3 was associated with in‐hospital mortality and three‐month mortality 2. A previous study also reported a strong correlation between ECOG PS and survival in patients with lung cancer and other malignancies 26…”

Section: Discussionmentioning

confidence: 99%

“…It is estimated that 8–15% of patients with lung cancer have malignant plural effusion (MPE). MPE accounts for 22% of all pleural effusion cases, and >150 000 new cases are diagnosed annually in the United States 2. Carcinoma of any organ can metastasize to the pleura, and when malignant cells are detected in pleural fluid or tissue, they denote advanced malignancy and poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

Predictors of survival in patients who underwent video‐assisted thoracic surgery talc pleurodesis for malignant pleural effusion

et al. 2016

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BackgroundPatients with malignant pleural effusion have a limited life expectancy. An increase in pleural and oncological treatment options and more accurate prognostic evaluation may help individualize treatment strategies. The aim of this study was to identify the prognostic indicators of overall survival (OS) after video‐assisted thoracic surgery (VATS) talc pleurodesis for malignant pleural effusion.MethodsWe examined the medical records of all consecutive patients with malignant pleural effusion who underwent VATS talc pleurodesis from 2006 to 2008 at the Samsung Medical Center. Univariate and multivariate analyses were used to identify predictors of OS after VATS talc pleurodesis.ResultsDuring the study period, 91 patients underwent VATS talc pleurodesis to treat malignant pleural effusion. Early (within 30 days) and late (within 90 days) postoperative mortality rates were 9.9% (9 patients), and 25.3% (23), respectively. Median survival time after VATS talc pleurodesis was 10.5 months. The postoperative respiratory complication rate was 11% (10 patients), and included pneumonia (9) and acute respiratory distress syndrome (4). Multivariate analysis revealed that preoperative chemotherapy (P = 0.012), preoperative radiotherapy (P = 0.003), and Eastern Cooperative Oncology Group (ECOG) performance score 3 or 4 (P = 0.013) were independent risk factors of OS after VATS talc pleurodesis.ConclusionsWe identified previous chemotherapy or radiotherapy and poor performance status (ECOG 3 or 4) as significant predictors of OS after VATS talc pleurodesis. These prognostic factors can help surgeons select candidates for VATS pleurodesis for malignant pleural effusion.

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“…A pleurodesis sclerosing agent is administered into the pleural space with an intercostal catheter/tube or by the thoracoscopic talc poudrage method (7)(8)(9). Commonly used sclerosing agents are talc, tetracyclines, and bleomycin (1,3,9). The success rate is 81-100% for talc, 65-76% for tetracycline, and 61% for bleomycin (1,3,9,10).…”

Section: Pleurodesismentioning

confidence: 99%

“…Malignant pleural effusions constitute 22% of all pleural effusions, and more than 150,000 new cases are diagnosed each year in the United States (1). Malignant pleural effusion occurs with the primary cancer of any organ metastasis to pleura and indicates a poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

Surgical Procedures Performed in Management of Malignant Pleural Effusions

Laçin¹,

Topçu²

2015

Eurasian J Pulmonol

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Malignant pleural effusion is one of the most common clinical problems in neoplastic diseases. There is no optimum treatment available. Pleurodesis is the most frequent method used for the treatment of malignant pleural effusion. However, in cases where pleurodesis failed more invasive procedures such as permanent catheter application, pleurectomy, decortication and extrapleural pneumonectomy can be used. In this paper, surgical treatment of malignant pleural effusion, were evaluated by reviewing the most recent articles.

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Management of Malignant Pleural Effusions

Cited by 445 publications

References 174 publications

Retrospective analysis of unknown primary cancers with malignant pleural effusion at initial diagnosis

Retrospective analysis of unknown primary cancers with malignant pleural effusion at initial diagnosis

Predictors of survival in patients who underwent video‐assisted thoracic surgery talc pleurodesis for malignant pleural effusion

Surgical Procedures Performed in Management of Malignant Pleural Effusions

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