Skip to main content

Advertisement

SpringerLink
Log in

Malignant Pleural Effusions—Personalised Management

  • Pulmonology and Respiratory Care (D Breen, Section Editor)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Malignant pleural effusions (MPEs) are frequent and are associated with significant morbidity and mortality. This article reviews the most recent literature on the management of MPE.

Recent Findings

With an increasing focus on personalised medicine, the primary treatment aims have changed from the primary aim of recurrence prevention to symptom control and quality of life improvement. Dependent on patient preference, options available to achieve such targets include repeated aspiration, talc pleurodesis (either through a small-bore chest drain or at thoracoscopy), and indwelling pleural catheters (IPCs). There is a consensus regarding the use of IPC in cases of trapped lung and failed talc pleurodesis, but two recent randomised controlled trials have proposed the use of IPCs as first-line therapy.

Conclusion

MPE management should be personalised, considering factors such as predicted survival, performance status, social support, local expertise and, most importantly, patient preference. IPCs are now more widely available as a treatment option and should be explored as a first-line treatment in selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Gurung P, Goldblatt MR, Huggins JT, Doelken P, Sahn SA. Pleural fluid characteristics of paramalignant effusion. Chest. 2009;136(4):44S.

    Article  Google Scholar 

  2. Hsu C. Cytologic detection of malignancy in pleural effusion: a review of 5,255 samples from 3,811 patients. Diagn Cytopathol. 1987;3(1):8–12.

    Article  PubMed  CAS  Google Scholar 

  3. Johnston WW. The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients. Cancer. 1985;56(4):905–9.

    Article  PubMed  CAS  Google Scholar 

  4. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii32–40.

    Article  PubMed  Google Scholar 

  5. Marosi C, Köller M. Challenge of cancer in the elderly. ESMO Open. 2016;1(3):e000020.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schiphorst AHW, Ten Bokkel Huinink D, Breumelhof R, JPJ B, Pronk A, Hamaker M. Geriatric consultation can aid in complex treatment decisions for elderly cancer patients. Eur J Cancer Care (Engl). 2016;25(3):365–70.

    Article  CAS  Google Scholar 

  7. Taghizadeh N, Fortin M, Tremblay AUS. Hospitalizations for malignant pleural effusions: data from the 2012 national inpatient sample. Chest. 2017;151(4):845–54.

    Article  PubMed  Google Scholar 

  8. Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan-Evans N, et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014;69(12):1098–104.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Clive AO, Jones HE, Bhatnagar R, Preston NJ, Maskell N. Interventions for the management of malignant pleural effusions: a network meta-analysis. Cochrane Database Syst Rev. 2016;5:CD010529.

    Google Scholar 

  10. Diacon AH, Wyser C, Bolliger CT, Tamm M, Pless M, Perruchoud AP, et al. Prospective randomized comparison of thoracoscopic talc poudrage under local anesthesia versus bleomycin instillation for pleurodesis in malignant pleural effusions. Am J Respir Crit Care Med. 2000;162(4 Pt 1):1445–9.

    Article  PubMed  CAS  Google Scholar 

  11. Bilaceroglu S, Guo Y, Hawthorne ML, Zhu Z, Stathopoulos GT, Lane KB, et al. Oral forms of tetracycline and doxycycline are effective in producing pleurodesis. Chest. 2005;128(5):3750–6.

    Article  PubMed  CAS  Google Scholar 

  12. Kennedy L, Rusch VW, Strange C, Ginsberg RJ, Sahn SA. Pleurodesis using talc slurry. Chest. 1994;106(2):342–6.

    Article  PubMed  CAS  Google Scholar 

  13. Caglayan B, Torun E, Turan D, Fidan A, Gemici C, Sarac G, et al. Efficacy of iodopovidone pleurodesis and comparison of small-bore catheter versus large-bore chest tube. Ann Surg Oncol. 2008;15(9):2594–9.

    Article  PubMed  Google Scholar 

  14. Clementsen P, Evald T, Grode G, Hansen M, Krag Jacobsen G, Faurschou P. Treatment of malignant pleural effusion: pleurodesis using a small percutaneous catheter. A prospective randomized study. Respir Med. 1998;92(3):593–6.

    Article  PubMed  CAS  Google Scholar 

  15. Bouchama A, Chastre J, Gaudichet A, Soler P, Gibert C. Acute pneumonitis with bilateral pleural effusion after talc pleurodesis. Chest. 1984;86(5):795–7.

    Article  PubMed  CAS  Google Scholar 

  16. Rinaldo JE, Owens GR, Rogers RM. Adult respiratory distress syndrome following intrapleural instillation of talc. J Thorac Cardiovasc Surg. 1983;85(4):523–6.

    PubMed  CAS  Google Scholar 

  17. Brant A, Eaton T. Serious complications with talc slurry pleurodesis. Respirol Carlton Vic. 2001;6(3):181–5.

    Article  CAS  Google Scholar 

  18. Maskell NA, Lee YCG, Gleeson FV, Hedley EL, Pengelly G, Davies RJO. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004;170(4):377–82.

    Article  PubMed  Google Scholar 

  19. •• Janssen JP, Collier G, Astoul P, Tassi GF, Noppen M, Rodriguez-Panadero F, et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet Lond Engl. 2007;369(9572):1535–9. This study revealed the serious adverse events rate associated with talc pleurodesis is significantly lower than previously reported in studies from the United States.

    Article  Google Scholar 

  20. Hooper C, Lee YCG, Maskell N. BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(Suppl 2):ii4–17.

    Article  PubMed  Google Scholar 

  21. Stefani A, Natali P, Casali C, Morandi U. Talc poudrage versus talc slurry in the treatment of malignant pleural effusion. A prospective comparative study. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2006;30(6):827–32.

    Article  Google Scholar 

  22. Dresler CM, Olak J, Herndon JE, Richards WG, Scalzetti E, Fleishman SB, et al. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest. 2005;127(3):909–15.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bhatnagar R, Laskawiec-Szkonter M, Piotrowska HEG, Kahan BC, Hooper CE, Davies HE, et al. Evaluating the efficacy of thoracoscopy and talc poudrage versus pleurodesis using talc slurry (TAPPS trial): protocol of an open-label randomised controlled trial. BMJ Open. 2014;4(11):e007045.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rahman NM, Ali NJ, Brown G, Chapman SJ, Davies RJO, Downer NJ, et al. Local anaesthetic thoracoscopy: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii54–60.

    Article  PubMed  Google Scholar 

  25. Bhatnagar R, Maskell NA. Indwelling pleural catheters. Respiration. 2014;88(1):74–85.

    Article  PubMed  Google Scholar 

  26. •• Davies HE, Mishra EK, Kahan BC, Wrightson JM, Stanton AE, Guhan A, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA. 2012;307(22):2383–9. This large randomised controlled study showed no difference between IPC insertion and talc pleurodesis in the control of dyspnoea symptoms in patients with MPE.

    Article  PubMed  CAS  Google Scholar 

  27. •• Thomas R, Fysh ETH, Smith NA, Lee P, Kwan BCH, Yap E, et al. Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion: the AMPLE randomized clinical trial. JAMA. 2017;318(19):1903–12. This study revealed IPC insertion was associated with less days spent in hospital when compared to talc pleurodesis.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Olfert JAP, Penz ED, Manns BJ, Mishra EK, Davies HE, Miller RF, et al. Cost-effectiveness of indwelling pleural catheter compared with talc in malignant pleural effusion. Respirol Carlton Vic. 2017;22(4):764–70.

    Article  Google Scholar 

  29. Van Meter MEM, 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(1):70–6.

    Article  PubMed  Google Scholar 

  30. Fysh ETH, Tremblay A, Feller-Kopman D, Mishra EK, Slade M, Garske L, et al. Clinical outcomes of indwelling pleural catheter-related pleural infections: an international multicenter study. Chest. 2013;144(5):1597–602.

    Article  PubMed  Google Scholar 

  31. Mekhaiel E, Kashyap R, Mullon JJ, Maldonado F. Infections associated with tunnelled indwelling pleural catheters in patients undergoing chemotherapy. J Bronchol Interv Pulmonol. 2013;20(4):299–303.

    Article  Google Scholar 

  32. Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT. The eighth edition lung cancer stage classification. Chest. 2017;151(1):193–203.

    Article  PubMed  Google Scholar 

  33. Egan AM, McPhillips D, Sarkar S, Breen DP. Malignant pleural effusion. QJM Mon J Assoc Physicians. 2014;107(3):179–84.

    Article  CAS  Google Scholar 

  34. Tao H, Meng Q, Li M, Shi L, Tang J, Liu Z. Outcomes of bevacizumab combined with chemotherapy in lung adenocarcinoma-induced malignant pleural effusion. Thorac Cancer. 2018;9(2):298–304.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Bhatnagar R, Keenan EK, Morley AJ, Kahan BC, Stanton AE, Haris M, et al. Outpatient talc administration by indwelling pleural catheter for malignant effusion. N Engl J Med. 2018;378(14):1313–22.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Interventional Respiratory Unit, Galway University Hospital, Newcastle Road, Galway, H91 YR71, Ireland

    Mohammed Ahmed

  2. Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    John M. Wrightson

Authors
  1. Mohammed Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John M. Wrightson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammed Ahmed.

Ethics declarations

Conflict of Interest

Mohammed Ahmed and John Wrightson declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pulmonology and Respiratory Care

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahmed, M., Wrightson, J.M. Malignant Pleural Effusions—Personalised Management. Curr Geri Rep 7, 154–159 (2018). https://doi.org/10.1007/s13670-018-0246-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13670-018-0246-0

Keywords

Search

Navigation