Predictors of outcome of pleurodesis in patients with malignant pleural effusion: a systematic review and meta-analysis

Hassan, Maged; Gadallah, Mohamed M.; Mercer, Rachel; Harriss, Elinor; Rahman, Najib M.

doi:10.1080/17476348.2020.1746647

Cited by 11 publications

(7 citation statements)

References 49 publications

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“…CRD42018115874). The primary outcome of the review along with the full search strategy and risk of bias assessment are reported elsewhere [ 5 ]. The literature search was carried out on Medline, Embase and Cochrane Database of Clinical trials on 12th November 2018 and updated for the purpose of this review on 1st July 2020.…”

Section: Methodsmentioning

confidence: 99%

Survival and pleurodesis outcome in patients with malignant pleural effusion – a systematic review

Hassan

Harriss

Mercer

et al. 2021

Pleura and Peritoneum

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Malignant pleural effusion (MPE) is a common condition that presents with progressive breathlessness. Long term solutions are often required due to recurrence of effusion after simple drainage. Pleurodesis is one of the main options resorted to for long term control of MPE. There is data to suggest there may be a survival benefit for patients with MPE who achieve successful pleurodesis. A systematic review was carried out to explore this correlation and results suggest that there could be a survival difference according to pleurodesis outcome in patients with MPE. Fifteen studies (reported in 13 papers) were included; 13 (86.6%) of the studies showed survival difference in favour of pleurodesis success. The median [interquartile range] difference in survival between the two groups among the different studies was five [3.5–5.8] months. Most of the included studies suffered moderate to severe risk of bias and, thus, large prospective studies of patients undergoing pleurodesis are required to ascertain this effect.

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Section: Methodsmentioning

confidence: 99%

Survival and pleurodesis outcome in patients with malignant pleural effusion – a systematic review

Hassan

Harriss

Mercer

et al. 2021

Pleura and Peritoneum

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“…Patients in the IPC group had larger effusions, and more were receiving systemic steroid therapy at the time of trial recruitment; which may have had an effect. [13,14] The IPC-PLUS trial, which primarily examined pleurodesis outcomes via an IPC, reported a 43% pleurodesis success rate at 35 days post-talc insufflation, [2] which is slightly higher than the rate of pleurodesis success at Day 30 (35%) in this study. However, differences in drainage protocols (affecting the degree of pleural apposition) and patient selection may account for this disparity.…”

Section: Discussionmentioning

confidence: 54%

The impact of outpatientversusinpatient management on health-related quality of life outcomes for patients with malignant pleural effusion: the OPTIMUM randomised clinical trial

Sivakumar,

Fitzgerald,

et al. 2023

Eur Respir J

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BackgroundThe principal aim of malignant pleural effusion (MPE) management is to improve health related quality of life (HRQoL) and symptoms.MethodsIn this open-label randomised controlled trial, patients with symptomatic MPE were randomly assigned to either IPC insertion with the option of talc pleurodesis or chest drain and talc pleurodesis. The primary endpoint was global health status, measured with the EORTC QLQ-C30 questionnaire at 30 days post-intervention. 142 participants were enrolled from July 2015 to December 2019.ResultsOf participants randomly assigned to IPC (n=70) and chest drain (n=72), primary outcome data were available in 58 and 56 patients, respectively. Global health status improved in both groups at day 30 compared to baseline: IPC (mean difference 13.11 p=0.001) and chest drain (mean difference 10.11 p=0.001). However, there was no significant between-group difference at day 30 (mean inter-group difference in baseline-adjusted global health status of 2.06 ([95% CI −5.86 to 9.99]; p=0.61), day 60 or day 90. No significant differences were identified between groups in breathlessness and chest pain scores. All chest drain arm patients were admitted (median length of stay 4 days); 7 in the IPC arm required intervention-related hospitalization.ConclusionWhile HRQoL significantly improved in both groups, there were no differences in patient reported global health status at 30 days. The outpatient pathway using an IPC was not superior to inpatient treatment with a chest drain.Trial Registration: ISRCTN registration:15503522.

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“…However, there have been contradictory results. A metaanalysis of 42 studies demonstrated that the strongest predictors of pleurodesis success were higher pleural fluid pH, smaller volume of effusion before pleurodesis and full lung re-expansion after effusion drainage (34). Higher pleural fluid glucose, lower LDH, lower pleural tumour burden, and shorter duration of tube drainage seem to favour pleurodesis success.…”

Section: Discussionmentioning

confidence: 99%

“…Higher pleural fluid glucose, lower LDH, lower pleural tumour burden, and shorter duration of tube drainage seem to favour pleurodesis success. However, data from these studies were limited by statistical heterogeneity (34). It is not known how well serum biomarkers correlate with pleural inflammation.…”

Section: Discussionmentioning

confidence: 99%

Systemic Inflammatory Response to Different Sclerosing Agents as a Predictor of Pleurodesis Outcome

Zablockis

Danila

Gruslys

et al. 2021

In Vivo

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Background/Aim: The objectives of this study were to evaluate systemic inflammation using different sclerosing agents and to estimate the prediction of systemic inflammation for the efficacy of pleurodesis. Patients and Methods: Ninetysix patients with recurrent and symptomatic malignant pleural effusion were enrolled in this retrospective study. We used serum C-reactive protein (CRP) levels, serum leukocyte counts and neutrophil-to-lymphocyte ratios (NLRs) as parameters of systemic inflammatory reactions. Evaluations of these parameters were performed before and 24 h after pleurodesis. Results: Pleurodesis was successful in 81 (84.4%) patients. The non-graded talc induced the highest changes in serum CRP levels, total white blood cell and neutrophil counts compared to other agents, while mitoxantrone induced the lowest. Graded talc and bleomycin induced the same levels of changes in serum CRP levels and serum leukocyte counts. The change in serum NLR was the same for all agent groups. Logistic regression confirmed that a change in serum CRP levels [odds ratio (OR)=0.92, p=0.002] and previous chemotherapy (OR=3.31, p=0.012) were independent predictors of pleurodesis efficacy. Conclusion: Pleurodesis agents induced a systemic inflammatory response at different levels. The change in serum CRP levels could be useful for predicting the success of pleurodesis.Approximately half of all patients with metastatic cancer develop malignant pleural effusion (MPE), which is likely to lead to a significant reduction in their quality of life, secondary to symptoms such as dyspnoea and cough (1). The main goals of MPE treatment are to decrease symptoms and improve quality of life (2). Pleurodesis with chemical agents is the most commonly used treatment for MPE (3). Talc is the most frequently used sclerosing agent (4). Nevertheless, talc pleurodesis can manifest some severe complications, such as hypoxia and acute respiratory distress syndrome (5-9). These complications are less frequent after the use of talc with large particles (10-13). Other agents, such as tetracycline derivates, silver nitrate, povidone-iodine, mitoxantrone, doxycycline and bleomycin have also been used, with variable efficacy and safety (14). The search for the most effective and safe agent for chemical pleurodesis is ongoing (15).Pleurodesis involves the induction of acute pleural inflammation, which, if sufficiently intense, progresses to pleural fibrosis that obliterates the pleural cavity and prevents the reaccumulation of fluid ( 16). The inflammatory mechanisms involved in this process are not yet fully understood. The manifested inflammatory reaction can be divided into a systemic and local response. The intensity of inflammatory activity in the pleural cavity may predict the efficacy of pleurodesis (17). However, there is a lack of research comparing systemic inflammation induced by different sclerosing agents.The objectives of this study were to evaluate the systemic inflammation induced by different sclerosing agents in patients with MPE and to ...

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Predictors of outcome of pleurodesis in patients with malignant pleural effusion: a systematic review and meta-analysis

Cited by 11 publications

References 49 publications

Survival and pleurodesis outcome in patients with malignant pleural effusion – a systematic review

Survival and pleurodesis outcome in patients with malignant pleural effusion – a systematic review

The impact of outpatientversusinpatient management on health-related quality of life outcomes for patients with malignant pleural effusion: the OPTIMUM randomised clinical trial

Systemic Inflammatory Response to Different Sclerosing Agents as a Predictor of Pleurodesis Outcome

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