Palliation and Pleurodesis in Malignant Pleural Effusion The Role for Tunneled Pleural Catheters

Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center,1275 York Avenue, New York, NY 10065, USA.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer (Impact Factor: 5.28). 02/2011; 6(4):762-7. DOI: 10.1097/JTO.0b013e31820d614f
Source: PubMed


Despite increasing use of tunneled pleural catheters (TPCs), their efficacy as a definitive procedure for achieving palliation or spontaneous pleurodesis (SP) in the management of malignant pleural effusion (MPE) remains unclear. In the largest TPC series to date, we evaluate the efficacy for palliation and review the rate and predictors of SP.
Retrospective review of 418 TPCs (355 patients) over 2 years (September 2007-September 2009) was performed. Palliation was deemed successful when the patient did not require any other subsequent effusion-directed drainage procedure. SP was defined as satisfying the following criteria: (a) TPC removal without need for further effusion-directed intervention during the patient's lifespan and (b) no evidence of effusion reaccumulation by clinical and radiographic evidence at 1-month postremoval follow-up.
After TPC placement, no subsequent effusion-directed procedure was required for 380 of 418 (91%). SP was achieved after only 26% of TPCs (110 of 418), in which the median time to catheter removal was 44 days. Neither demographics nor primary tumor type predicted SP. In patients selected for TPC placement in the operating room, SP occurred in 36% (39 of 107), with 45% in loculated MPE (13 of 29, p = 0.014). Complications occurred after 20 TPCs (4.8%), with none occurring after bedside placement.
TPC placement is safe and provides durable palliation, most often obviating the need for subsequent procedures in MPE patients. TPC, however, remains suboptimal at achieving pleurodesis.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The use of indwelling pleural catheters (IPC) has an established place in the management of malignant pleural effusion (MPE) when pleurodesis has failed or is unsuitable. The use of IPC as a frontline therapy in place of pleurodesis is also gathering momentum. Recent studies confirmed that IPCs provide similar improvement in symptoms and quality of life, and requires fewer hospital days, when compared against talc pleurodesis. Adverse events related to IPC treatment are uncommon and generally mild. Comparing the cost-effectiveness of IPC and pleurodesis is difficult and remains a contentious issue. Patients with a MPE are a heterogeneous group; it is likely some patients may benefit more from IPC and others from pleurodesis. How best to identify these subgroups is of high priority in MPE research. In the meantime, patients should be offered both options of IPC and pleurodesis (if no contraindication), and patient preference incorporated into the decision process.
    Full-text · Article · Jun 2013
  • Source

    Full-text · Article · Apr 2011 · Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Malignant pleural effusions (MPE) are a common complication of advanced malignancy. The treatment of MPE should be focused on palliation of associated symptoms. The traditional approach to MPE has been to attempt pleurodesis by introducing a sclerosant into the pleural space. A more recent development in the treatment of MPE has been the use of indwelling pleural catheters (IPC) for ongoing drainage of the pleural space. Controversy exists as to which approach is superior. Pleurodesis approaches will have the advantage of a time-limited course of treatment and high pleurodesis rate at the cost of a more invasive procedure requiring a general anaesthetic or conscious sedation (for thoracoscopic approaches) and an inpatient hospital stay. Use of IPC will allow the patient to be treated on an outpatient basis with a minimally invasive procedure, at the cost of long-term need for catheter drainage and care. Symptom control appears similar between techniques. Complication rates between the two approaches cannot be easily compared, but studies suggest more frequent severe complications such as respiratory failure, arrhythmias and even mortality following pleurodesis, with infection rates similar between the two approaches. IPC will likely see increasing utilization in the future but patient preference and local resources and expertise will continue to play a significant part in treatment decisions. Randomized trials directly comparing the two approaches are needed and some are underway. Novel combination approaches utilizing both IPC and pleurodesis agents have the potential to further improve the care of these patients.
    Preview · Article · May 2011 · Respirology
Show more