Management of Malignant Pleural Effusions—What Is New

Thomas, Rajesh; Roy, Bapti; Maldonado, Fabien; Lee, Y.C. Gary

doi:10.1055/s-0039-1698285

Cited by 17 publications

(20 citation statements)

References 96 publications

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“…[1][2][3] However, in recent years, a number of randomized clinical trials and high-quality studies have shown IPC to be effective and similar to pleurodesis in terms of symptom control and improvement of the quality of life, and with significant benefits for patients such as ambulatory management and the need for fewer additional pleural procedures. [4][5][6] Recent systematic reviews comparing the effectiveness of IPC versus pleurodesis concluded that the two approaches share a similar success rate for the control of MPE.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10] The latest recommendations for the treatment of MPE therefore position IPC as a first-line treatment for the management of MPE. [4][5][6] The choice between IPC and pleurodesis should be based on the risk/benefit balance in each case and the cost of each procedure. [4][5][6] Cost-effectiveness analyses are an economic evaluation model that provides a framework for comparison of the cost and clinical outcomes of health care interventions.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] The choice between IPC and pleurodesis should be based on the risk/benefit balance in each case and the cost of each procedure. [4][5][6] Cost-effectiveness analyses are an economic evaluation model that provides a framework for comparison of the cost and clinical outcomes of health care interventions. 11,12 Although the cost of outpatient management is generally accepted to be lower compared with hospital treatment, the available evidence on the costs of IPC is based on a series of studies with limited caseloads and different designs.…”

Section: Introductionmentioning

confidence: 99%

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Cost Effectiveness of Malignant Pleural Effusion with Indwelling Catheter: Systematic Review

Botana-Rial

Ramos-Hernández

Lojo-Rodríguez

et al. 2021

Journal of Palliative Medicine

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Background: The current cost of treatment of malignant pleural effusion (MPE) with an indwelling pleural catheter (IPC) is unclear.Objective: We propose a review of the scientific evidence on the cost and effectiveness of this therapeutic option. Methods: Systematic review of the literature on the cost and effectiveness of the treatment of MPE by IPC, according to the PRISMA methodology and quality according to the scientific guidelines. Results: A total of 4 articles, 152 patients, and 159 IPCs were included. The use of IPC was associated with improvement in symptoms and quality of life. The most common complications were infections (empyema in 20.9% of patients and cellulitis in 17.3%); 9% of cases were hospitalized due to complications, and <2% required subsequent procedures. The average cost of IPC (set/drainage bottles) ranged from e2,025.6 to e1,200.5 if it was placed on an outpatient basis, e1,100 if survival was <6 weeks, and e4,028 in patients with mesothelioma. Complications increased the cost, and taking into account follow-up visits, additional tests, and days of admission for complications, the cost was >e5,000. Compared with pleurodesis, the cost of IPC was significantly lower when patient survival was <14 weeks, but not when survival was longer or home care was required. Conclusions: The use of IPC is associated with good control of MPE and seldom requires many subsequent procedures; however, it is also associated with a certain rate of complications, which may increase costs. However, ambulatory management may help reduce costs, which are directly related to the type of tumor, the duration of survival, and the need for specialized treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost Effectiveness of Malignant Pleural Effusion with Indwelling Catheter: Systematic Review

Botana-Rial

Ramos-Hernández

Lojo-Rodríguez

et al. 2021

Journal of Palliative Medicine

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“…The NCCN Guidelines make it clear that cytological specimens are available for genetic testing. Malignant pleural effusion exists in nearly half of advanced NSCLC patients [2-4], which is a convenient cytological specimen for gene detection, but most cancerous pleural effusion is bloody. Bloody pleural effusion (BPE) were usually centrifuged or made cell blocks for the next nucleic acid extraction and genetic testing.…”

Section: Introductionmentioning

confidence: 99%

Using Disposable Membrane Cell Collector to Enrich Lung Adenocarcinoma Cells in Bloody Pleural Effusion for Anaplastic Lymphoma Kinase Fusion Gene Detection

Guo

Zhao

et al. 2021

Acta Cytologica

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Purpose: For anaplastic lymphoma kinase (ALK) gene detection, the centrifugal sedimentation method (CSM) and cell block method (CBM) are commonly used to process samples of bloody pleural effusions (BPEs). However, in practice, the impurity content in the processed samples often affects the results and even leads to the detection failure. The purpose of this study was to establish a cell enrichment method (CEM) by using a disposable membrane cell collector to remove blood and inflammatory cells and enrich lung adenocarcinoma cells in BPE for more efficient RNA extraction and ALK gene detection. Materials and Methods: CEM proposed in this study and the traditional CSM and CBM were used to treat BPE samples collected from 37 lung adenocarcinoma patients. A DeNovix DS-11 ultraviolet spectrophotometer was used to measure the concentration and purity of extracted RNA. Amplification refractory mutation systems (ARMS) and ABI 7500 fluorescence qPCR were used to detect ALK gene. Through statistical analysis, the CEM was compared with the CSM and CBM in RNA concentration, purity, and ALK gene detection results. Results: The concentration of RNA extracted by using the CEM was significantly higher than that extracted by using the CBM and CSM (p < 0.001). The purity of RNA extracted by using the CEM was significantly higher than that by the other 2 methods (p = 0.011, p = 0.005). ALK gene testing with PCR was successful in all the samples using the CEM, but 2 cases by the CSM and 1 case by the CBM failed. Conclusions: Using the disposable membrane cell collector to process BPE of lung adenocarcinoma patients for RNA extraction and ALK gene detection is more effective and successful compared with the traditional methods, and it is suggested to be further applied and popularized in clinical practice.

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“…Malignant pleural effusion (MPE), often originates from most malignant tumors, is a common and challenging problem. Patients often suffer from breathlessness, poor quality of life (QOL) and prognosis [1][2]. Control of the effusion signi cantly reduces morbidity, and improves quality of life.…”

Section: Introductionmentioning

confidence: 99%

Intrathoracic infusion therapy of thymic peptides and chemical irritants for malignant pleural effusion: a meta-analysis of 24 randomized controlled trials

Xiao¹,

Wang²,

He³

et al. 2020

Preprint

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Background: To further determine the clinical efficacy and survival of intrathoracic infusion with TPs and chemical irritants and their therapeutic threshold and optimal control regimen to achieve a desired response in malignant pleural effusion (MPE).Methods: We collected all randomized controlled trials (RCTs) of TPs with chemical irritants from Chinese and English databases (from inception until September 2019), and performed a new metaanalysis following the PRISMA guidelines. We measured their bias risk, summarized data using metaanalysis, and evidence quality using the Grades of Recommendation Assessment, Development and Evaluation approach. Results: We collected 24 trials involving three TPs and platinum and 1,592 patients. Most trials had unclear bias risk. TPs with platinum significantly improved complete response [4.02 (3.12 to 5.18)] and quality of life [3.64 (2.34 to 5.66)], the 0.5-year overall survival (OS) rate [5.75 (3.02 to 10.92)], and 1-year OS rate [5.29, (1.71 to 16.36)], and reduced the treatment failure, myelosuppression, and gastrointestinal toxicity. For patients with moderate to large volume of pleural effusion, KPS score ≥50 to 60, or AST ≥3 months, the thymosin (200-300mg/time), thymopentin (2mg/time) or thymosin alpha 1 (3.2mg/time) with cisplatin (30-40mg/m 2 ), carboplatin (400mg/m 2 ), or oxaliplatin (100mg/m 2 ) are possible regimens for achieving a desired success, and low failure. Most results were robust and moderate quality. Conclusion: The moderate evidence suggests that the TPs with platinum is beneficial to the patient with MPE, and provides evidence for the therapeutic threshold and possible regimens that may achieve a desired success and reduce the failure. Background Malignant pleural effusion (MPE), often originates from most malignant tumors, is a common and challenging problem. Patients often suffer from breathlessness, poor quality of life (QOL) and prognosis [1-2]. Control of the effusion significantly reduces morbidity, and improves quality of life. Chemical pleurodesis is a first-line intervention for MPE without a nonexpendable lung (NEL) [3]. After draining effusion, a chemical irritant such as talc poudrage [4], tetracycline [5], bleomycin [6],

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Management of Malignant Pleural Effusions—What Is New

Cited by 17 publications

References 96 publications

Cost Effectiveness of Malignant Pleural Effusion with Indwelling Catheter: Systematic Review

Cost Effectiveness of Malignant Pleural Effusion with Indwelling Catheter: Systematic Review

Using Disposable Membrane Cell Collector to Enrich Lung Adenocarcinoma Cells in Bloody Pleural Effusion for Anaplastic Lymphoma Kinase Fusion Gene Detection

Intrathoracic infusion therapy of thymic peptides and chemical irritants for malignant pleural effusion: a meta-analysis of 24 randomized controlled trials

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