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Integrated Palliative Care of Respiratory Disease pp 103–119Cite as

Malignant Pleural Effusions and Mesothelioma

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Abstract

Pleural effusions are a common problem in the palliative phase of a number of different conditions and usually indicate advanced or metastatic disease. They are associated with a significant symptom burden. The investigation of a unilateral pleural effusion starts with ultrasound-guided pleural aspiration, followed if necessary by thoracoscopy or CT-guided biopsy. The recurrent symptomatic effusion can be drained, but without pleurodesis is likely to recur. The options for pleurodesis and the role of indwelling pleural catheters are discussed. The chapter then describes the epidemiology and presenting features of malignant pleural mesothelioma. Management strategies include preventing recurrence of the effusion, symptom control with drugs, and consideration of the appropriateness of chemotherapy. There is rarely a place for surgery. As mesothelioma is ultimately fatal, there is discussion of management in advanced disease and in particular of peritoneal mesothelioma. Medicolegal aspects are also considered.

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References

  1. Clive AOJ, Bhatnagar R, Preston NJ, et al. Interventions for the management of malignant pleural effusions: a network meta-analysis. Cochrane Database Syst Rev. 2016;(5):CD010529.

    Google Scholar 

  2. Havelock T, et al. British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl II):4–76.

    Google Scholar 

  3. American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med. 2000;162:1987–2001.

    Article  Google Scholar 

  4. Woolhouse I, Bishop L, Darlison L, et al. British Thoracic Society guideline for the investigation and management of malignant pleural mesothelioma 2018. Thorax. 2018;73:i1–i30.

    Article  Google Scholar 

  5. Arnold DT, DeFonseka D, Perry S, et al. Investigating unilateral pleural effusions: the role of cytology. Eur Respir J. 2018;52(5):1801254. https://doi.org/10.1183/13993003.01254-2018.

    Article  CAS  PubMed  Google Scholar 

  6. Mummadi SK, Kumbam A, Hahn PY. Malignant pleural effusions and the role of talc poudrage and talc slurry: a systematic review and meta-analysis. F1000Research. 2014;3:254.

    Article  Google Scholar 

  7. Dresler CM, Olak J, Herndon JE 2nd, et al., Cooperative Groups Cancer and Leukaemia Group B, Eastern Cooperative Oncology Group, North Central Cooperative Oncology Group, Radiation Therapy Oncology Group. Phase III intergroup study of talc poudrage vs. talc slurry for malignant pleural effusions. Chest. 2005;127:909–915.

    Article  Google Scholar 

  8. Bhatnagar R, Laskawiec-Szkonter M, Piotrowska HEG, 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:e007045.

    Article  Google Scholar 

  9. Rintoul RC, Ritchie AJ, Edwards JG, et al. A multi-centre randomised control trial of video assisted thoracoscopic pleurectomy versus talc pleurodesis in malignant pleural mesothelioma. J Thorac Oncol. 2013;8:S2–3.

    Article  Google Scholar 

  10. Clementsen P, Evald T, Grode G, et al. Treatment of malignant pleural effusion: pleurodesis using a small percutaneous catheter. A prospective randomised study. Respir Med. 1998;92:593–6.

    Article  CAS  Google Scholar 

  11. Rahman NM, Pepperell J, Rehal S, et al. Effect of opioids vs. NSAIDs and larger vs. smaller chest tube size on pain control and pleurodesis efficacy among patients with malignant pleural effusion: the TIME1 randomised clinical trial. JAMA. 2015;314:2641–53.

    Article  CAS  Google Scholar 

  12. Davies HE, Mishra EK, Kahan BC, 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.

    Article  CAS  Google Scholar 

  13. Thomas R, Fysh EH, Smith NA, 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;318:1903–12.

    Article  Google Scholar 

  14. Muruganandan S, Azzopardi M, Fitzgerald DB, et al. Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open label randomised trial. Lancet Respir Med. 2018;6:671–80.

    Article  Google Scholar 

  15. Bhatnagar R, Keenan EK, Morley AJ, et al. Outpatient talc administration by indwelling pleural catheter for malignant effusion. NEJM. 2018;378:1313–22.

    Article  CAS  Google Scholar 

  16. Antony VB, Loddenkemper R, Astoul P, et al. Management of malignant pleural effusions. Am J Respir Crit Care Med. 2000;162:1987–2001.

    Article  Google Scholar 

  17. Zamboni MM, da Silva CT, Baretta R, et al. Important prognostic factors for survival in patients with malignant pleural effusions. BMC Pulm Med. 2015;15:29.

    Article  Google Scholar 

  18. Bielsa S, Salud A, Martinez M, et al. Prognostic significance of pleural fluid data in patients with malignant pleural effusion. Eur J Intern Med. 2008;19:334–9.

    Article  Google Scholar 

  19. Sahn SA, Good JT. Pleural fluid pH in malignant effusions. Diagnostic, prognostic and therapeutic implications. Ann Intern Med. 1988;108:345–9.

    Article  CAS  Google Scholar 

  20. Jimenez D, Diaz G, Gil D, et al. Etiology and prognostic significance of massive pleural effusions. Respir Med. 2005;99:1183–7.

    Article  Google Scholar 

  21. Clive AO, Kahan BC, Hooper CE, et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014;69:1098–104.

    Article  Google Scholar 

  22. Cigognetti M, Leonardi S, Fisogni S, et al. BAP1 (BRCA1-associated protein 1) is a highly specific marker for differentiating mesothelioma from reactive mesothelial proliferation. Mod Pathol. 2015;28:1043–57.

    Article  CAS  Google Scholar 

  23. American Cancer Society. Survival Statistics for Mesothelioma. 2016. Cancer.org. http://www.cancer.org/cancer/malignantmesothelioma-survival-statistics.

  24. Curran D, Sahmoud T, Therasse P, et al. Prognostic factors in patients with pleural mesothelioma: the European Organisation for Research and Treatment of Cancer experience. J Clin Oncol. 1998;16:145–52.

    Article  CAS  Google Scholar 

  25. Herndon JE, Green MR, Chahinian AP, et al. Factors predictive of survival among 337 patients with mesothelioma treated between 1984 and 1994 by the Cancer and Leukaemia Group B. Chest. 1998;113:723–31.

    Article  CAS  Google Scholar 

  26. Brims FJ, Maniawy TM, Duffus I, et al. A novel clinical prediction model for prognosis in malignant pleural mesothelioma using decision tree analysis. J Thorac Oncol. 2016;11:573–82.

    Article  Google Scholar 

  27. Chapman A, Mulrennan S, Ladd B, Muers MF. Population based epidemiology and prognosis of mesothelioma in Leeds, UK. Thorax. 2008;63:435–9.

    Article  CAS  Google Scholar 

  28. Royal College of Physicians. National mesothelioma audit report 2018 (for the audit period 2014–16). London: Royal College of Physicians; 2018.

    Google Scholar 

  29. Van Meerbeeck JP, et al. Randomised phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organisation for Research and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada. J Clin Oncol. 2005;23:6881–9.

    Article  Google Scholar 

  30. Vogelzang NJ, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003;21:2636–44.

    Article  CAS  Google Scholar 

  31. Zalcman G, Mazieres J, Margery J, et al. Bevacizumab 15 mg/kg plus cisplatin-pemetrexed (CP) triplet versus CP doublet in Malignant Pleural Mesothelioma (MPM): results of the IFCT-GFPC-0701 MAPS randomised phase 3 trial. J Clin Oncol. 2015;33(15 Suppl 1):7500.

    Article  Google Scholar 

  32. O’Brien MER, Watkins Ryan DC. A randomised trial in malignant mesothelioma of early versus delayed chemotherapy in symptomatically stable patients: the MED trial. Ann Oncol. 2006;17:270–5.

    Article  Google Scholar 

  33. Ball H, Moore S, Leary A. A systematic literature review comparing the psychological care needs of patients with mesothelioma and advanced lung cancer. Eur J Oncol Nurs. 2016;25:62–7.

    Article  Google Scholar 

  34. Moore S, Darlinson L, Tod AM. Living with mesothelioma. A literature review. Eur J Cancer Care. 2010;19:458–68.

    Article  CAS  Google Scholar 

  35. Becker G, Galandi D, Blum HE. Malignant ascites: systemic review and guideline for treatment. Eur J Cancer. 2006;42:589–97.

    Article  Google Scholar 

  36. Lee CW, Bociek G, Faught W. A survey of practice in management of malignant ascites. J Pain Symptom Manag. 1998;16:96–101.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Respiratory Medicine, North Tyneside General Hospital, Tyne and Wear, UK

    David Cooper

  2. Policy, Ethics and Life Sciences, Newcastle University, Newcastle Upon Tyne, UK

    Tim Peel

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  1. David Cooper
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  2. Tim Peel
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Correspondence to Tim Peel .

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Editors and Affiliations

  1. Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle Upon Tyne, UK

    Stephen J. Bourke

  2. Policy, Ethics and Life Sciences, Newcastle University, Newcastle Upon Tyne, UK

    Tim Peel

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Cooper, D., Peel, T. (2019). Malignant Pleural Effusions and Mesothelioma. In: Bourke, S., Peel, T. (eds) Integrated Palliative Care of Respiratory Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-18944-0_7

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  • DOI: https://doi.org/10.1007/978-3-030-18944-0_7

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