Malignant Pleural Effusion: Still a Long Way to Go

Author(s): Fausto Meriggi*.

Journal Name: Reviews on Recent Clinical Trials

Volume 14 , Issue 1 , 2019

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Graphical Abstract:


Abstract:

Background: Malignant pleural effusion, which is a common clinical problem in patients with cancer, may be due to both primary thoracic tumours or to a metastatic spread in the chest and constitutes the first sign of disease in approximately 10% of patients. Almost all cancers can potentially produce a pleural effusion. The presence of malignant tumour cells in the pleural fluid is generally indicative of advanced disease and is associated with high morbidity and mortality with reduced therapeutic options. Dyspnoea during mild physical activity or at rest is generally the typical sign of restrictive respiratory failure.

Methods: This is a systematic review of all the main articles in the English language on the topic of malignant pleural effusion and reported by the Pubmed database from 1959 to 2018. I reviewed the literature and guidelines with the aims to focus on what is known and on future pathways to follow the diagnosis and treatment of malignant pleural effusions.

Results: The main goal of palliation of a malignant pleural effusion is a quick improvement in dyspnoea, while thoracentesis under ultrasound guidance is the treatment of choice for patients with a limited life expectancy or who are not candidates for more invasive procedures such as drainage using an indwelling small pleural catheter, chemical pleurodesis with sclerosing agents, pleurectomy or pleuro-peritoneal shunt.

Conclusion: Despite progress in therapeutic options, the prognosis remains severe, and the average survival is 4-9 months from the diagnosis of malignant pleural effusion. Moreover, mortality is higher for patients with malignant pleural effusion compared with those with metastatic cancer but no malignant pleural effusion. Therefore, the prognosis of these patients primarily depends on the underlying disease and the extension of a primary tumour. This review focuses on the most relevant updates in the management of malignant pleural effusion.

Keywords: Cancer, clinical problem, dyspnoea, malignano pleural effusion, pleurodesis, thoracentesis.

[1]
American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med 2000; 162: 1987-2001.
[2]
Cohen S, Hossain SA. Primary carcinoma of the lung: A review of 417 histologically proved cases. Dis Chest 1966; 49: 67-74.
[3]
Emerson GL, Emerson MS, Sherwood CE. The natural history of carcinoma of the lung. J Thorac Surg 1959; 37: 291-304.
[4]
Johnston WW. The malignant pleural effusion: A review of cytopathologic diagnosis of 584 specimens from 472 consecutive patients. Cancer 1985; 56: 905-9.
[5]
Estenne M, Yernault JC, De Troyer A. Mechanism of relief of dyspnoea after thoracocentesis in patients with large pleural effusions. Am J Med 1983; 74: 813-9.
[6]
Light RW, Stansbury DW, Brown SE. The relationship between pleural pressures and changes in pulmonary function after therapeutic thoracentesis. Am J Respir Crit Care Med 1986; 133: 658-61.
[7]
Heffner J, Brown L, Barbieri C. Diagnostic value of tests that discriminate between exudative and transudative pleural effusions. Primary Study Investigators. Chest 1997; 111: 970-80.
[8]
Heffner JE, Klein JS. Recent advances in the diagnosis and management of malignant pleural effusions. Mayo Clin Proc 2008; 83: 235-50.
[9]
Heffner JE, Klein JS, Hampson C. Diagnostic utility and clinical application of imaging for pleural space infections. Chest 2010; 137: 467-79.
[10]
Marrazzo A, Noto A, Casa L, et al. Video-thoracoscopic surgical pleurodesis in the management of malignant pleural effusion: The importance of an early intervention. J Pain Symptom Manage 2005; 30: 75-9.
[11]
Ferreiro L, Suárez-Antelo J, Valdés L. Pleural procedures in the management of malignant effusions. Ann Thorac Med 2017; 12: 3-10.
[12]
Basso SM, Mazza F, Marzano B, et al. Improved quality of life in patients with malignant pleural effusion following videoassisted thoracoscopic talc pleurodesis. Preliminary results. Anticancer Res 2012; 32: 5131-4.
[13]
Roberts ME, Neville E, Berrisford RG, et al. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65(Suppl. 2): ii32.
[14]
Davies HE, Lee YC. Management of malignant pleural effusions: questions that need answers. Curr Opin Pulm Med 2013; 19: 374-9.
[15]
Ost DE, Niu J, Zhao H, Grosu HB, Giordano SH. Quality gaps and comparative effectiveness of management strategies for recurrent malignant pleural effusions. Chest 2018; 153: 438-52.
[16]
Demmy TL, Gu L, Burkhalter JE, et al. Optimal management of malignant pleural effusion (result of CALGB 30102). J Natl Compr Canc Netw 2012; 10: 975-82.
[17]
Feller-Kopman D, Walkey A, Berkowitz D, Ernst A. The relationship of pleural pressure to symptom development during therapeutic thoracentesis. Chest 2006; 129: 1556-60.
[18]
Feller-Kopman D, Berkowitz D, Boiselle P, Ernst A. Large-volume thoracentesis and the risk of reexpansion pulmonary edema. Ann Thorac Surg 2007; 84: 1656-61.
[19]
Doelken P, Huggins JT, Pastis NJ, Sahn SA. Pleural manometry: Technique and clinical implications. Chest 2004; 126: 1764-9.
[20]
Gordon CE, Feller-Kopman D, Balk EM, et al. Pneumothorax following thoracentesis: A systematic review and meta-analysis. Arch Intern Med 2010; 170: 332-9.
[21]
Wahidi MM, Reddy C, Yarmus L, et al. Randomized trial of pleural fluid drainage frequency in patients with malignant pleural effusions. The ASAP Trial. Am J Respir Crit Care Med 2017; 195: 1050-7.
[22]
Sabur NF, Chee A, Stather DR, et al. The impact of tunneled pleural catheters on the quality of life of patients with malignant pleural effusions. Respiration 2013; 85: 36-42.
[23]
Boshuizen RC, Vd Noort V, Burgers JA, et al. A randomized controlled trial comparing indwelling pleural catheters with talc pleurodesis (NVALT-14). Lung Cancer 2017; 108: 9-14.
[24]
van den Toorn LM, Schaap E, Surmont VF, et al. Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter. Lung Cancer 2005; 50: 123-7.
[25]
Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest 2006; 129: 362-8.
[26]
Warren WH, Kalimi R, Khodadadian LM, Kim AW. Management of malignant pleural effusions using the Pleural catheter. Ann Thorac Surg 2008; 85: 1049-55.
[27]
Fysh ET, Waterer GW, Kendall PA, et al. Indwelling pleural catheters reduce inpatient days over pleurodesis for malignant pleural effusion. Chest 2012; 142: 394-400.
[28]
Hunt BM, Farivar AS, Vallières E, et al. Thoracoscopic talc versus tunneled pleural catheters for palliation of malignant pleural effusions. Ann Thorac Surg 2012; 94: 1053-7.
[29]
Fysh ET, Tremblay A, Feller-Kopman D, et al. Clinical outcomes of indwelling pleural catheter-related pleural infections: An international multicenter study. Chest 2013; 144: 1597-602.
[30]
Rial MB, Lamela IP, Fernández VL, et al. Management of malignant pleural effusion by an indwelling pleural catheter: A cost-efficiency analysis. Ann Thorac Med 2015; 10: 181-4.
[31]
Thomas R, Fysh ETH, 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.
[32]
Fortin M, Tremblay A. Pleural controversies: Indwelling pleural catheter vs. pleurodesis for malignant pleural effusions. J Thorac Dis 2015; 7: 1052-7.
[33]
Freeman RK, Ascioti AJ, Mahidhara RS. A propensity-matched comparison of pleurodesis or tunneled pleural catheter in patients undergoing diagnostic thoracoscopy for malignancy. Ann Thorac Surg 2013; 96: 259-63.
[34]
Pien GW, Gant MJ, Washam CL, Sterman DH. Use of an implantable pleural catheter for trapped lung syndrome in patients with malignant pleural effusion. Chest 2001; 119: 1641-6.
[35]
Thornton RH, Miller Z, Covey AM, et al. Tunneled pleural catheters for treatment of recurrent malignant pleural effusion following failed pleurodesis. J Vasc Interv Radiol 2010; 21: 696-700.
[36]
Bibby AC, Clive AO, Slade GC, et al. Survival in patients with malignant pleural effusions who developed pleural infection: A retrospective case review from six UK centers. Chest 2015; 148: 235-41.
[37]
Gilbert CR, Lee HJ, Skalski JH, et al. The use of indwelling tunneled pleural catheters for recurrent pleural effusions in patients with hematologic malignancies: A multicenter study. Chest 2015; 148: 752-8.
[38]
Lorenzo MJ, Modesto M, Pérez J, et al. Quality-of-Life assessment in malignant pleural effusion treated with indwelling pleural catheter: a prospective study. Palliat Med 2014; 28: 326-34.
[39]
Hak CC, Sivakumar P, Ahmed L. Safety of indwelling pleural catheter use in patients undergoing chemotherapy: A five-year retrospective evaluation. BMC Pulm Med 2016; 16: 41.
[40]
Faiz SA, Pathania P, Song J, et al. Indwelling pleural catheters for patients with hematologic malignancies. A 14-Year, Single-Center experience. Ann Am Thorac Soc 2017; 14: 976-85.
[41]
Tremblay A, Mason C, Michaud G. Use of tunnelled catheters for malignant pleural effusions in patients fit for pleurodesis. Eur Respir J 2007; 30: 759-62.
[42]
Abrão FC, Abreu IR, Cavalcanti MG, Pompa-Filho JF. Use of indwelling pleural catheters for the definitive treatment of malignant pleural effusion. J Bras Pneumol 2017; 43: 14-7.
[43]
Reddy C, Ernst A, Lamb C, Feller-Kopman D. Rapid pleurodesis for malignant pleural effusions: A pilot study. Chest 2011; 139: 1419-23.
[44]
Fysh ET, Wrightson JM, Lee YC, Rahman NM. Fractured indwelling pleural catheters. Chest 2012; 141: 1090-4.
[45]
Pollak JS. Malignant pleural effusions: Treatment with tunneled long-term drainage catheters. Curr Opin Pulm Med 2002; 8: 302-7.
[46]
Pollak JS, Burdge CM, Rosenblatt M, et al. Treatment of malignant pleural effusions with tunneled long- term drainage catheters. J Vasc Interv Radiol 2001; 12: 201-8.
[47]
Ahmed L, Ip H, Rao D, et al. Talc pleurodesis through indwelling pleural catheters for malignant pleural effusions: Retrospective case series of a novel clinical pathway. Chest 2014; 146: e190-4.
[48]
Saffran L, Ost DE, Fein AM, Schiff MJ. Outpatient pleurodesis of malignant pleural effusions using a small-bore pigtail catheter. Chest 2000; 118: 417-21.
[49]
Bazerbashi S, Villaquiran J, Awan MY, et al. Ambulatory intercostal drainage for the management of malignant pleural effusion: A single center experience. Ann Surg Oncol 2009; 16: 3482-7.
[50]
Waissberg D, Ben-Zeev I. Talc pleurodesis: Experience with 360 patients. J Thorac Cardiovasc Surg 1993; 106: 689-95.
[51]
Cardillo G, Facciolo F, Carbone L, et al. Long-term follow-up of video-assisted talc pleurodesis in malignant recurrent pleural effusions. Eur J Cardiothorac Surg 2002; 21: 302-5.
[52]
Shaw P, Agarwald R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev 2006; 1: CD002916.
[53]
Davies HE, Mishra EK, Kahan BC, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for reliving dyspnea in patients with malignant pleural effusion. The TIME2 randomized controlled trail. JAMA 2012; 307: 2383-9.
[54]
Clive AO, Jones HE, Bhatnagar R, et al. Interventions for the management of malignant pleural effusions: A network meta-analysis. Cochrane Database Syst Rev 2016; 5: CD010529.
[55]
Tan C, Sedrakyan A, Browne J, et al. The evidence on the effectiveness of management for malignant pleural effusion: A systematic review. Eur J Cardiothorac Surg 2006; 29: 829-38.
[56]
Steger V, Mika U, Toomes H, et al. Who gains most? A 10-year experience with 611 thoracoscopic talc pleurodeses. Ann Thorac Surg 2007; 83: 1940-5.
[57]
Yildirim H, Metintas M, Ak G, et al. Predictors of talc pleurodesis outcome in patients with malignant pleural effusions. Lung Cancer 2008; 62: 139-44.
[58]
Spiegler PA, Hurewitz AN, Groth ML. Rapid pleurodesis for malignant pleural effusions. Chest 2003; 123: 1895-8.
[59]
Bielsa S, Hernández P, Rodriguez-Panadero F, et al. Tumor type influences the effectiveness of pleurodesis in malignant effusions. Lung 2011; 189: 151-5.
[60]
Dresler CM, Olak J, Herndon JE 2nd, et al. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest 2005; 127: 909-15.
[61]
Bhatnagar R, Keenan EK, Morley AJ, et al. Outpatient Talc Administration by Indwelling Pleural Catheter for Malignant Effusion. N Engl J Med 2018; 378: 1313-22.
[62]
Kara M, Alzafer S, Okur E, Halezeroglu S. The use of single incision thoracoscopic pleurectomy in the management of malignant pleural effusion. Acta Chir Belg 2013; 113: 270-4.
[63]
Nakas A, Martin Ucar AE, Edwards JG, Waller DA. The role of video assisted thoracoscopic pleurectomy/decortication in the therapeutic management of malignant pleural mesothelioma. Eur J Cardiothorac Surg 2008; 33: 83-8.
[64]
Flores RM, Pass HI, Seshan VE, et al. Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: Results in 663 patients. J Thorac Cardiovasc Surg 2008; 135: 620-6.
[65]
Rintoul RC, Ritchie AJ, Edwards JG, et al. Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): An open-label, randomised, controlled trial. Lancet 2014; 384: 1118-27.
[66]
Petrou M, Kaplan D, Goldstraw P. Management of recurrent malignant pleural effusions: The complimentary role talc pleurodesis and pleuroperitoneal shunting. Cancer 1995; 75: 801-5.
[67]
Genc O, Petrou M, Ladas G, Goldstraw P. The long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions. Eur J Cardiothorac Surg 2000; 18: 143-6.
[68]
Khiatani V, Isaacson A, Yu H, Stavas J. Interventional radiologic placement of Denver pleuroperitoneal shunt for refractory chylothorax. J Vasc Interv Radiol 2013; 24: 1073-4.
[69]
Shimmyo T, Morita K, Mineshita M, et al. Pleuroperitoneal shunt for chylothorax and chylopericardium in lung cancer: A case report. Ann Thorac Cardiovasc Surg 2011; 17: 63-6.
[70]
Jones DR, Taylor MD, Petroni GR, et al. Phase I trial of intrapleural docetaxel administered through an implantable catheter in subjects with a malignant pleural effusion. J Thorac Oncol 2010; 5: 75-81.
[71]
Seto T, Ushijima S, Yamamoto H, et al. Intrapleural hypotonic cisplatin treatment for malignant pleural effusion in 80 patients with non-small-cell lung cancer: A multi-institutional phase II trial. Br J Cancer 2006; 95: 717-21.
[72]
Işık AF, Sanlı M, Yılmaz M, et al. Intrapleural hyperthermic perfusion chemotherapy in subjects with metastatic pleural malignancies. Respir Med 2013; 107: 762-7.
[73]
Marquez-Medina D, Popat S. Closing faucets: The role of anti-angiogenic therapies in malignant pleural diseases. Clin Transl Oncol 2016; 18: 760-8.
[74]
Masago K, Fujimoto D, Fujita S, et al. Response to bevacizumab combination chemotherapy of malignant pleural effusions associated with non-squamous non-small-cell lung cancer. Mol Clin Oncol 2015; 3: 415-9.
[75]
Du N, Li X, Li F, et al. Intrapleural combination therapy with bevacizumab and cisplatin for non-small cell lung cancer‐mediated malignant pleural effusion. Oncol Rep 2013; 29: 2332-40.
[76]
Jänne PA, Yang JC, Kim DW, et al. AZD9291 in EGFR inhibitor-resistant non-small-cell lung cancer. N Engl J Med 2015; 372: 1689-99.
[77]
Mok TS, Wu YL, Thongprasert S, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009; 361: 947-57.
[78]
Jiang T, Li A, Su C, et al. Addition of bevacizumab for malignant pleural effusion as the manifestation of acquired EGFR-TKI resistance in NSCLC patients. Oncotarget 2017; 8: 62648-57.
[79]
Chen Y, Mathy NW, Lu H. The role of VEGF in the diagnosis and treatment of malignant pleural effusion in patients with non-small cell lung cancer (Review). Mol Med Rep 2018; 17: 8019-30.
[80]
Psallidas I, Kanellakis NI, Gerry S, et al. Development and validation of response markers to predict survival and pleurodesis success in patients with malignant pleural effusion (PROMISE): A multicohort analysis. Lancet Oncol 2018; 19: 930-9.
[81]
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.
[82]
Abrao F, Campello de Oliveira M, et al. Prognostic factors for mortality in malignant pleural effusion: Is it possible to predict survival?”. Proc ASCO 2017; 35(suppl 15): Abst. e21638
[83]
Heffner JE. Management of malignant pleural effusions UpToDate 2018.


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Article Details

VOLUME: 14
ISSUE: 1
Year: 2019
Page: [24 - 30]
Pages: 7
DOI: 10.2174/1574887114666181204105208
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