Malignant pleural effusions: a review.

Malignant pleural effusions are a cause of significant symptoms and distress in patients with end-stage malignancies and portend a poor prognosis. Management is aimed at symptom relief, with minimally invasive interventions and minimal requirement for hospital length of stay. The management options include watchful waiting if no symptoms are present, repeat thoracentesis, medical or surgical thoracoscopic techniques to achieve pleurodesis, pleuroperitoneal shunts, placement of tunneled pleural catheters, or a combination of modalities. To determine the best modality for management, patients must be assessed individually with concern for symptoms, functional status, prognosis, and their social and financial situations.

[1]  A. Musani Treatment options for malignant pleural effusion , 2009, Current opinion in pulmonary medicine.

[2]  J. Herndon,et al.  Malignant pleural effusions: treatment with small-bore-catheter thoracostomy and talc pleurodesis. , 1999, Radiology.

[3]  J. Heffner,et al.  Pleural fluid pH as a predictor of pleurodesis failure: analysis of primary data. , 2000, Chest.

[4]  A. Fidan,et al.  Efficacy of Iodopovidone Pleurodesis and Comparison of Small-Bore Catheter Versus Large-Bore Chest Tube , 2008, Annals of Surgical Oncology.

[5]  W. Johnston The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients , 1985, Cancer.

[6]  J. Ruckdeschel Management of malignant pleural effusions. , 1995, Seminars in oncology.

[7]  M. Noppen,et al.  Advanced techniques in medical thoracoscopy , 2006, European Respiratory Journal.

[8]  J. M. Tura,et al.  Talc preparations used for pleurodesis vary markedly from one preparation to another. , 2001, Chest.

[9]  J. Beamis,et al.  Efficacy of short term versus long term tube thoracostomy drainage before tetracycline pleurodesis in the treatment of malignant pleural effusions. , 1994, Thorax.

[10]  Y. Zhang,et al.  Vascular endothelial growth factor and soluble intercellular adhesion molecule-1 in lung adenocarcinoma with malignant pleural effusion: correlations with patient survival and pleural effusion control. , 2012, Neoplasma.

[11]  I. Fentiman,et al.  Control of pleural effusions in patients with breast cancer a randomized trial , 1983, Cancer.

[12]  C. Strange,et al.  A comparison of rotation and nonrotation in tetracycline pleurodesis. , 1993, Chest.

[13]  J. Whang‐Peng,et al.  Phase II trial of intrapleural paclitaxel injection for non-small-cell lung cancer patients with malignant pleural effusions. , 1998, Respiratory medicine.

[14]  V. Zagonel,et al.  Intrapleural paclitaxel for malignant pleural effusion from ovarian and breast cancer: a phase II study with pharmacokinetic analysis , 2012, Cancer Chemotherapy and Pharmacology.

[15]  D. Feller-Kopman,et al.  Large-volume thoracentesis and the risk of reexpansion pulmonary edema. , 2007, The Annals of thoracic surgery.

[16]  P. C. Meyer Metastatic carcinoma of the pleura. , 1966, Thorax.

[17]  S. Burks,et al.  Phase I Trial of Intrapleural Docetaxel Administered Through an Implantable Catheter in Subjects with a Malignant Pleural Effusion , 2010, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[18]  P. Clementsen,et al.  Treatment of malignant pleural effusion: pleurodesis using a small percutaneous catheter. A prospective randomized study. , 1998, Respiratory medicine.

[19]  F. Matzinger,et al.  Pleurodesis with Iodized Talc for Malignant Effusions Using Pigtail Catheters , 1998, The Annals of pharmacotherapy.

[20]  D. Waller,et al.  Open lung-sparing surgery for malignant pleural mesothelioma: the benefits of a radical approach within multimodality therapy. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[21]  Helen H. W. Chen,et al.  Combined Intrapleural and Intravenous Chemotherapy, and Pulmonary Irradiation, for Treatment of Patients with Lung Cancer Presenting with Malignant Pleural Effusion , 2002, Oncology.

[22]  M. Charbonneau,et al.  Thoracoscopy for the diagnosis of pleural disease. , 1991, Annals of internal medicine.

[23]  Sharyn I. Katz,et al.  A trial of intrapleural adenoviral-mediated Interferon-α2b gene transfer for malignant pleural mesothelioma. , 2011, American journal of respiratory and critical care medicine.

[24]  P. Goldstraw,et al.  The long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions. , 2000, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[25]  S. Sahn,et al.  Management of malignant pleural effusions. , 2001, The European respiratory journal.

[26]  R. Light,et al.  Malignant pleural effusion: would the real cause please stand up? , 1997, The European respiratory journal.

[27]  S. Sahn,et al.  Carcinomatous involvement of the pleura: an analysis of 96 patients. , 1977, The American journal of medicine.

[28]  S. Halezeroğlu,et al.  Streptokinase for malignant pleural effusions: a randomized controlled study , 2011, Asian cardiovascular & thoracic annals.

[29]  F. Gleeson,et al.  Intrapleural streptokinase in the management of malignant multiloculated pleural effusions. , 1999, Chest.

[30]  P. Goldstraw,et al.  Management of malignant pleural effusions. , 2001, The European respiratory journal.

[31]  Edmund Neville,et al.  Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010 , 2010, Thorax.

[32]  F. Rodríguez‐Panadero,et al.  Pleural metastatic tumours and effusions. Frequency and pathogenic mechanisms in a post-mortem series. , 1989, The European respiratory journal.

[33]  W. Warren,et al.  Management of malignant pleural effusions using the Pleur(x) catheter. , 2008, The Annals of thoracic surgery.

[34]  D. Marmé,et al.  Vascular endothelial growth factor in the sera and effusions of patients with malignant and nonmalignant disease , 1999, Cancer.

[35]  S. Sherman Reexpansion pulmonary edema: a case report and review of the current literature. , 2003, The Journal of emergency medicine.

[36]  L. S. Broderick,et al.  Reexpansion Pulmonary Edema , 1996, Journal of thoracic imaging.

[37]  W. Parulekar,et al.  Use of small-bore vs large-bore chest tubes for treatment of malignant pleural effusions. , 2001, Chest.

[38]  M. Fukuoka,et al.  Intrapleural Administration of Cisplatin and Etoposide to Treat Malignant Pleural Effusions in Patients with Non-Small Cell Lung Cancer , 1999, Chemotherapy.

[39]  E. Neville,et al.  BTS guidelines for the management of malignant pleural effusions. , 2003, Thorax.

[40]  F. Schramel,et al.  Distribution of talc suspension during treatment of malignant pleural effusion with talc pleurodesis. , 2002, Lung cancer.

[41]  D. Maziak,et al.  Surgical management of malignant pleural mesothelioma: a systematic review and evidence summary. , 2005, Lung cancer.

[42]  R. Davies,et al.  Pleurodesis for malignant pleural effusion: talc, toxicity and where next? , 2008, Thorax.

[43]  H. Wada,et al.  Phase II study of repeated intrapleural chemotherapy using implantable access system for management of malignant pleural effusion. , 2002, Chest.

[44]  I. Sayek,et al.  Treatment of malignant pleural effusion: a method using tube thoracostomy and talc. , 1976, The Annals of thoracic surgery.

[45]  R. Light,et al.  Systemic corticosteroids decrease the effectiveness of talc pleurodesis. , 1998, American journal of respiratory and critical care medicine.

[46]  M. Mencoboni,et al.  Carboplatin and cisplatin pharmacokinetics after intrapleural combination treatment in patients with malignant pleural effusion. , 1997, Annals of oncology : official journal of the European Society for Medical Oncology.

[47]  E. Beattie,et al.  Management of malignant pleural effusions with pleuroperitoneal shunting. , 1994, Journal of the American College of Surgeons.

[48]  T. Treasure,et al.  The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[49]  D. Keena PLEURAL DISEASES, 5TH EDITION , 2008 .

[50]  L. Valdés,et al.  The etiology of pleural effusions in an area with high incidence of tuberculosis. , 1996, Chest.

[51]  R. Davies,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. , 2012, JAMA.

[52]  Y. Ichinose,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 , 2006, British Journal of Cancer.

[53]  Y. C. Lee,et al.  Indwelling pleural catheters reduce inpatient days over pleurodesis for malignant pleural effusion. , 2012, Chest.

[54]  J. Aparicio,et al.  Malignant Pleural Effusion: Prognostic Factors for Survival and Response to Chemical Pleurodesis in a Series of 120 Cases , 1998, Respiration.

[55]  E. Beattie,et al.  Pleuroperitoneal shunt for malignant pleural effusions: a one-year experience. , 1993, Seminars in surgical oncology.

[56]  A. Musani,et al.  Management of malignant pleural effusions , 2012, Current Respiratory Care Reports.

[57]  P. Goldstraw,et al.  Pleuroperitoneal shunt for recurrent malignant pleural effusions. , 1990, Thorax.

[58]  H. Colt,et al.  Advances in Thoracoscopy: 100 Years since Jacobaeus , 2010, Respiration.

[59]  J. Dunning,et al.  Does re-expansion pulmonary oedema exist? , 2008, Interactive cardiovascular and thoracic surgery.

[60]  R. Davies,et al.  Pleurodesis practice for malignant pleural effusions in five English-speaking countries: survey of pulmonologists. , 2003, Chest.

[61]  J. Peto,et al.  Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study , 2011, The Lancet. Oncology.

[62]  S. Sahn Malignant Pleural Effusions , 1985, Clinics in chest medicine.

[63]  Meiping Liu,et al.  Intrapleural Urokinase for the Treatment of Loculated Malignant Pleural Effusions and Trapped Lungs in Medically Inoperable Cancer Patients , 2006, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[64]  Mitchell Ho,et al.  A Phase I Clinical Trial of Single-Dose Intrapleural IFN-β Gene Transfer for Malignant Pleural Mesothelioma and Metastatic Pleural Effusions: High Rate of Antitumor Immune Responses , 2007, Clinical Cancer Research.

[65]  S. Hajdu,et al.  The cytologic diagnosis of malignant neoplasms in pleural and peritoneal effusions. , 1987, Acta cytologica.

[66]  R. Light,et al.  The incidence of pleural effusion in a well-defined region. Epidemiologic study in central Bohemia. , 1993, Chest.

[67]  Y. Matsuzaki,et al.  Intrapleural hyperthermic perfusion with chemotherapy increases apoptosis in malignant pleuritis. , 2004, The Annals of thoracic surgery.

[68]  R. Agarwal,et al.  Pleurodesis for malignant pleural effusions. , 2013, The Cochrane database of systematic reviews.

[69]  Y. Aelony,et al.  Thoracoscopic talc poudrage in malignant pleural effusions: effective pleurodesis despite low pleural pH. , 1998, Chest.

[70]  Sen-ming Wang,et al.  Intrapleural Chemo- and Hyperthermotherapies for Malignant Pleural Effusion: A Randomized Prospective Study , 2012, Cancer investigation.

[71]  R. Light,et al.  The effect of corticosteroids on pleurodesis induced by doxycycline in rabbits. , 2002, Chest.

[72]  E. Marchi,et al.  Influence of antiinflammatory drugs (methylprednisolone and diclofenac sodium) on experimental pleurodesis induced by silver nitrate or talc. , 2005, Chest.

[73]  H. Kato,et al.  A prematurely terminated phase III trial of intraoperative intrapleural hypotonic cisplatin treatment in patients with resected non-small cell lung cancer with positive pleural lavage cytology: the incidence of carcinomatous pleuritis after surgical intervention. , 2002, The Journal of thoracic and cardiovascular surgery.

[74]  M. Florence,et al.  Respiratory failure following talc pleurodesis. , 1999, American journal of surgery.

[75]  H. Colt Thoracoscopy. A prospective study of safety and outcome , 1997 .

[76]  P. Silverman,et al.  Using urokinase to treat malignant pleural effusions. , 1999, AJR. American journal of roentgenology.

[77]  P. Dohrmann,et al.  Effective treatment of malignant pleural effusion by minimal invasive thoracic surgery: thoracoscopic talc pleurodesis and pleuroperitoneal shunts in 101 patients. , 2001, The Annals of thoracic surgery.

[78]  D. Feller-Kopman,et al.  Rapid pleurodesis for malignant pleural effusions: a pilot study. , 2011, Chest.

[79]  A. Billé,et al.  What is the best treatment for malignant pleural effusions? , 2011, Interactive cardiovascular and thoracic surgery.

[80]  M. Noppen,et al.  Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study , 2007, The Lancet.

[81]  N. Karamanos,et al.  Management of malignant pleural effusion by suicide gene therapy in advanced stage lung cancer: a case series and literature review , 2012, Cancer Gene Therapy.

[82]  Y. Erozan,et al.  Efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of malignant neoplasm involving the pleura. , 1975, Chest.

[83]  E. Scalzetti,et al.  Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. , 2005, Chest.

[84]  A. Tremblay,et al.  Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. , 2005, Chest.

[85]  G. Colditz,et al.  Treatment of malignant pleural effusion: a cost-effectiveness analysis. , 2012, The Annals of thoracic surgery.

[86]  D. Sterman,et al.  Novel Intrapleural Therapies for Malignant Diseases , 2012, Respiration.

[87]  C. Hsu,et al.  Cytologic detection of malignancy in pleural effusion: A review of 5,255 samples from 3,811 patients , 1987, Diagnostic cytopathology.

[88]  P. Spiegler,et al.  Rapid pleurodesis for malignant pleural effusions. , 2003, Chest.

[89]  R. Xie,et al.  Advanced Malignant Pleural or Peritoneal Effusion in Patients Treated with Recombinant Adenovirus p53 Injection plus Cisplatin , 2008, The Journal of international medical research.

[90]  D. Feller-Kopman,et al.  The relationship of pleural pressure to symptom development during therapeutic thoracentesis. , 2006, Chest.

[91]  R. Kohlwes,et al.  Efficacy and Safety of Tunneled Pleural Catheters in Adults with Malignant Pleural Effusions: A Systematic Review , 2010, Journal of General Internal Medicine.

[92]  K. Kovitz,et al.  A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions , 1999, Cancer.

[93]  R. Davies,et al.  Intrapleural use of tissue plasminogen activator and DNase in pleural infection. , 2011, The New England journal of medicine.

[94]  F. Rodríguez‐Panadero,et al.  Mechanisms of Pleurodesis , 2012, Respiration.

[95]  P. E. Cardoso,et al.  Thoracoscopy talc poudrage : a 15-year experience. , 2001, Chest.

[96]  F. Hausheer,et al.  Diagnosis and treatment of malignant pleural effusion , 1985, Cancer and Metastasis Reviews.

[97]  A. Livartowski,et al.  Use of a subcutaneous implantable pleural port in the management of recurrent malignant pleurisy: five-year experience based on 168 subcutaneous implantable pleural ports. , 2011, Journal of palliative medicine.