Management of Malignant Pleural Effusions in Breast Cancer
Carcinomatous pleurisy is often a manifestation of malignant disease and an indicator of the terminal stage of disease. Breast carcinoma is one of the most common neoplasms and causes approximately one third of all malignant pleural effusions (MPE). The ideal treatment is to remove the fluid and prevent its re-accumulation. Various methods, such as thoracentesis, chest tube drainage, permanent catheter placement, talc or other adhesive molecule uses, and video-assisted thoracoscopic surgery (VATS), have been used to create pleural symphysis. Repeated thoracentesis controls less than 15% of the effusions. A tunneled indwelling pleural catheter (TIPC) may improve symptoms for patients with MPE and does not appear to be associated with major complications; additionally, this method does not require hospitalization. TIPC also prevents the pain and complications that are associated with chemical agents. Pleurodesis with VATS has very high efficacy in terms of effusion control if preoperative indications (complete pulmonary expansion) are respected. The advantage of pleurodesis with VATS is the possibility of conducting the procedure in direct view and achieving uniform talc distribution, even in the most inaccessible areas. Bedside talc pleurodesis has a high success rate when thoracoscopy is unavailable.
KeywordsBreast carcinoma Thoracentesis Chest tube drainage Permanent catheters Talc poudrage Pleurodesis Thoracoscopy Re-accumulation Lung re-expansion Trapped lung Talc pleurodesis Sclerosing agent Doxycycline pleurodesis Bleomycin Erythromycin c-ErbB-2 (a type of receptor tyrosine kinase) Malignant pleural effusions (MPE) Video-assisted thoracoscopic surgery (VATS) Tunneled indwelling pleural catheter (TIPC)
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