The management of malignant effusions from breast cancer

Abstract

We have reviewed our experience with 50 patients with malignant effusion secondary to breast cancer. Prior to any therapy for this problem the malignant cause of the effusion must be firmly established. Permanent cell block with cytologic examination of such cells proved exceedingly accurate in our hands. Once the diagnosis is known secondary to malignancy the type of effusion must be investigated since those in which there are a large number of free cells or diffuse serosal studding respond best to intracavitary therapy. Those in which the effusion is due to lymphatic or venous blockage secondary to a single large tumor mass do not respond well to intracavitary therapy. Forty‐nine of our patients had pleural effusion and were treated either by aspiration of fluid alone, aspiration of fluid combined with systemic treatment, or aspiration of fluid combined with intracavitary administration of radioactive gold, or nitrogen mustard. In the course of their therapy each patient averaged 6 thoracenteses prior to symptomatic relief, and usually remained symptom free after a course of treatment. An interval of 19 months from the time of the appearance of the effusion until death was found in the 38 patients who have succumbed to their disease ‐in the 12 who are still living 54 months have passed since initial appearance of their effusion to the present time. We believe that effusion is not a signal of the last stage of this disease and should be aggressively treated.

Results of chemical pleurodesis with mitoxantrone in malignant pleural effusion from breast cancer

“…In all of the studies, except for the study reported by Rojato et al [14], the mean or median survival after the onset of pleural effusion ranges from 6 to 15 months, indicating a poor prognosis for this group of patients.…”

“…As shown in our study pleural effusion can occur as early as 1 month or as late as 19 years with a median interval of 27 months. Rojato et al [14], Raju et al [15], and Fentiman et al [16] have shown a median lag time of 24, 22 and 41.5 months respectively. When effusion occurs within 1 month of diagnosis of breast cancer, one is probably dealing with stage IV disease and clinical experience has proved that these patients have an generally poor prognosis.…”

Tratamiento de los derrames pleurales malignos con quimioterapia sistémica, después del drenaje con tubo de tórax.

“…Entre las diferentes modalidades terapéuticas para el derrame pleural, están la toracentesis, toracostomía con drenaje cerrado, pleurectomía, derivaciones pleuroperitoneales y la pleurodesis química, la cual es bastante utilizada, pero no es etiológica ni fisiológica 18,19 ; además, se han reportado en diferentes estudios los efectos de la absorción sistémica de algunos de los agentes empleados en dicho procedimiento, que pueden estar relacionados con síndrome de dificultad respiratoria aguda en algunas ocasiones 20,21 Los catéteres pleurales permanentes son una alternativa cada vez más usada para reemplazar la pleurodesis, permitiendo el drenaje domiciliario y manejo ambulatorio, aunque se asocia más con efectos adversos 22 .…”