Management of Malignant Pleural Effusions

Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, Texas, USA.
Advances in Therapy (Impact Factor: 2.27). 06/2010; 27(6):334-47. DOI: 10.1007/S12325-010-0031-8
Source: PubMed


Malignant pleural effusions are a common clinical problem in patients with primary thoracic malignancy and metastatic malignancy to the thorax. Symptoms can be debilitating and can impair tolerance of anticancer therapy. This article presents a comprehensive review of pharmaceutical and nonpharmaceutical approaches to the management of malignant pleural effusion, and a novel algorithm for management based on patients' performance status.

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Available from: M.P. Kennedy, Aug 20, 2014
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    • "The recommendation for management of malignant PE is to proceed with thoracentesis at diagnosis for pathological confirmation of malignancy. Pleurodesis is indicated for patients with recurrent PE, dyspnea, and who do not respond to basic treatment of neoplasia [10, 11]. "
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    ABSTRACT: A consensus has not yet been reached for the ideal moment to carry out pleurodesis in patients with malignant pleural effusion among the majority of centres, especially those which don't specialise in oncologic treatment. The PET (positron emission tomography)/CT (computed tomography) used in the staging of patients with non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) has caused controversy when used in the evaluation of therapeutical response and in detection of recurrence in patients with pleurodesis. For not distinguishing between inflammatory and neoplasic processes while using PET or CT, suspicion of pleural involvement can result in the indication for invasive diagnostic procedures or inadequate exchange of therapy. In such cases, the hypothesis of the inflammatory process must be included in the differential diagnoses for positive findings with the PET/CT in patients with NSCLC who have undergone pleurodesis, independently of time since the procedure. The reports of two patients with NSCLC have been presented in order to illustrate situations in which pleurodesis has been performed at the moment of diagnosis, outside of a cancer centre.
    Full-text · Article · Aug 2014 · ecancermedicalscience
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    • "However, all management approaches remain palliative, and relief of dyspnea remains the primary objective. An algorithm based on various guidelines1,2,23,24 for the management of MPEs is shown in Figure 136. It is important to consider the patient's overall prognosis, symptoms, functional status, and social and financial situation when selecting the modality of choice. "
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    ABSTRACT: Malignant pleural effusions (MPEs) are the second leading cause of exudative pleural effusions after parapneumonic effusions. In the vast majority of cases, a MPE signifies incurable disease associated with high morbidity and mortality. Considerable advances have been made for the diagnosis of MPEs, through the development of improved methods in the specialized cytological and imaging studies. The cytological or histological confirmation of malignant cells is currently important in establishing a diagnosis. Furthermore, despite major advancements in cancer treatment for the past two decades, management of MPE remains palliative. This article presents a comprehensive review of the medical approaches for diagnosis and management of MPE.
    Full-text · Article · May 2014 · Tuberculosis and Respiratory Diseases
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    • "Malignant pleural effusion (MPE) is a common complication of patients with highly symptomatic and advanced-stages of lung cancer. In the clinic, these patients are difficult to manage and have, in general, a short life expectancy of 4–9 month after diagnosis [2]. In addition to lung cancer, MPE is a serious complication associated with different other tumor types including breast cancer and lymphomas affecting altogether 175,000 patients in the United States each year [3]. "
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    ABSTRACT: Background Malignant pleural effusion (MPE) is associated with advanced stages of lung cancer and is mainly dependent on invasion of the pleura and expression of vascular endothelial growth factor (VEGF) by cancer cells. As MPE indicates an incurable disease with limited palliative treatment options and poor outcome, there is an urgent need for new and efficient treatment options. Methods In this study, we used subcutaneously generated PC14PE6 lung adenocarcinoma xenografts in athymic mice that developed subcutaneous malignant effusions (ME) which mimic pleural effusions of the orthotopic model. Using this approach monitoring of therapeutic intervention was facilitated by direct observation of subcutaneous ME formation without the need of sacrificing mice or special imaging equipment as in case of MPE. Further, we tested oncolytic virotherapy using Vaccinia virus as a novel treatment modality against ME in this subcutaneous PC14PE6 xenograft model of advanced lung adenocarcinoma. Results We demonstrated significant therapeutic efficacy of Vaccinia virus treatment of both advanced lung adenocarcinoma and tumor-associated ME. We attribute the efficacy to the virus-mediated reduction of tumor cell-derived VEGF levels in tumors, decreased invasion of tumor cells into the peritumoral tissue, and to viral infection of the blood vessel-invading tumor cells. Moreover, we showed that the use of oncolytic Vaccinia virus encoding for a single-chain antibody (scAb) against VEGF (GLAF-1) significantly enhanced mono-therapy of oncolytic treatment. Conclusions Here, we demonstrate for the first time that oncolytic virotherapy using tumor-specific Vaccinia virus represents a novel and promising treatment modality for therapy of ME associated with advanced lung cancer.
    Full-text · Article · May 2013 · Journal of Translational Medicine
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