Methods for Treatment of Malignant Pleural Effusion

Alexei L. Charyshkin, Ekaterina A. Kuzmina, Bulat I. Khusnutdinov, Evgeniy A. Toneev, Vladimir I. Midlenko

 
International Journal of Biomedicine. 2020;10(1):16-19.
DOI: 10.21103/Article10(1)_RA2
Originally published March 15, 2020

Abstract: 

This brief review provides up-to-date information on the management of malignant pleural effusions (MPE). In general, selection of the most appropriate treatment approach should be individualized. Management of MPE relies on tumor type, pulmonary re-expansion, performance status, symptoms, and life expectancy. Pleurodesis and IPC placement are two effective treatments recommended for recurrent MPE, both of which can effectively improve dyspnea and quality of life of patients. Other options such as intrapleural therapies, radiation therapy, and pleuroperitoneal shunting are alternative treatments. However, most of these treatments are temporary, and MPE would recur soon. Hence, further palliative treatments to effectively control pleural effusions and relieve symptoms are necessary.

Keywords: 
malignant pleural effusions • thoracentesis • pleurodesis • indwelling pleural catheters
References: 
  1. Psallidas I, Kalomenidis I, Porcel JM, Robinson BW, Stathopoulos GT. Malignant pleural effusion: from bench to bedside. Eur Respir Rev. 2016;25(140):189-98. doi: 10.1183/16000617.0019-2016.
  2. Mongardon N, Pinton-Gonnet C, Szekely B, Michel-Cherqui M, Dreyfus JF, Fischler M. Assessment of chronic pain after thoracotomy: a 1-year prevalence study. Clin J Pain. 2011;27(8):677-81. doi: 10.1097/AJP.0b013e31821981a3.
  3. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ; BTS Pleural Disease Guideline Group. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65 Suppl 2:ii32-40. doi: 10.1136/thx.2010.136994.
  4. Kolschmann S, Ballin A, Gillissen A. Clinical efficacy and safety of thoracoscopic talc pleurodesis in malignant pleural effusions. Chest 2005;128(3):1431–5.
  5. Antony VB, Loddenkemper R, Astoul P, Boutin C, Goldstraw P, Hott J, et al. Management of malignant pleural effusions. Eur Respir J. 2001;18(2):402–19.
  6. Kasapoglu US, Arınç S, Gungor S, Irmak I, Guney P, Aksoy F, et al. Prognostic factors affecting survival in non-small cell lung carcinoma patients with malignant pleural effusions. Clin Respir J. 2016;10(6):791-799. doi: 10.1111/crj.12292.
  7. Mejer J, Mortensen KM, Hansen HH. Mepacrine hydrochloride in the treatment of malignant pleural effusion. A controlled randomized trial. Scand J Respir Dis. 1977;58(6):319–23.
  8. Yserbyt J, Dooms C. Malignant pleurisy and palliative therapy. Belg J Med Oncol. 2015;9:272–8.
  9. Martínez-Moragón E, Aparicio J, Sanchis J, Menéndez R, Cruz Rogado M, Sanchis F. Malignant pleural effusion: prognostic factors for survival and response to chemical pleurodesis in a series of 120 cases. Respiration. 1998;65(2):108-13.
  10. Wierman WH, Spencer JR. The role of thoracotomy and parietal pleurectomy in the diagnosis and treatment of pleural effusions. Am Surg. 1961;27:383-7.
  11. Jensik R, Cagle JE Jr, Milloy F, Perlia C, Taylor S, Kofman S, Beattie EJ Jr.  Pleurectomy in the treatment of pleural effusion due to metastatic malignancy. J Thorac Cardiovasc Surg. 1963;46:322-30
  12. Beattie EJ Jr. The treatment of malignant pleural effusions by partial pleurectomy. Surg Clin North Am. 1963;43:99-108
  13. Jones GR. Treatment of recurrent malignant pleural effusion by iodized talc pleurodesis. Thorax 1969;24(1):69-73
  14. Reshad K, Inui K, Takeuchi Y, Takahashi Y, Hitomi S. Treatment of malignant pleural effusion.  Chest 1985;88(3):393-7.
  15. Davies HE, Lee YC. Management of malignant pleural effusions: questions that need answers. Curr Opin Pulm Med. 2013;19(4):374-9. doi: 10.1097/MCP.0b013e3283615b67.
  16. Davies HE, Mishra EK, Kahan BC, Wrightson JM, Stanton AE, Guhan A, 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 Jun 13;307(22):2383-9. doi: 10.1001/jama.2012.5535.
  17. Egan AM, McPhillips D, Sarkar S, Breen DP. Malignant pleural effusion. QJM. 2014;107(3):179-84. doi: 10.1093/qjmed/hct245.
  18. Kastelik JA. Management of malignant pleural effusion. Lung. 2013 Apr;191(2):165-75. doi: 10.1007/s00408-012-9445-1.
  19. Bychkov MB. Tumor pleurisy (differential diagnosis and treatment). Russkii Medizinskii Zhurnal.1999;10:3
  20. Zarogoulidis K, Zarogoulidis P, Darwiche K, Tsakiridis K, Machairiotis N, Kougioumtzi I, et al. Malignant pleural effusion and algorithm management. J Thorac Dis. 2013;5 Suppl 4:S413-9. doi: 10.3978/j.issn.2072-1439.2013.09.04.
  21. Kaifi JT, Toth JW, Gusani NJ, Kimchi ET, Staveley-O'Carroll KF, Belani CP, Reed MF. Multidisciplinary management of malignant pleural effusion. J Surg Oncol. 2012;105(7):731-8. doi: 10.1002/jso.22100.
  22. Thomas JM, Musani AI. Malignant pleural effusions: a review. Clin Chest Med. 2013;34(3):459-71. doi: 10.1016/j.ccm.2013.05.004.
  23. Yazdanbod A, Salehifar A, Maleki N, Habibzadeh S, Tavosi Z. Successful use of central venous catheters in the management of recurrent malignant pleural effusions: one new option. Support Care Cancer. 2015;23(8):2267-71. doi: 10.1007/s00520-014-2595-3.
  24. Beyea A, Winzelberg G, Stafford RE. To drain or not to drain: an evidence-based approach to palliative procedures for the management of malignant pleural effusions. J Pain Symptom Manage. 2012;44(2):301-6. doi: 10.1016/j.jpainsymman.2012.05.002.
  25. Feller-Kopman D, Walkey A, Berkowitz D, Ernst A. The relationship of pleural pressure to symptom development during therapeutic thoracentesis. Chest. 2006;129(6):1556-60.
  26. Grogan DR, Irwin RS, Channick R, Raptopoulos V, Curley FJ, Bartter T, Corwin RW. Complications associated with thoracentesis. A prospective, randomized study comparing three different methods. Arch Intern Med. 1990; 150(4):873-7.  
  27. Quinn T, Alam N, Aminazad A, Marshall MB, Choong CK. Decision making and algorithm for the management of pleural effusions. Thorac Surg Clin. 2013;23(1):11-6, v. doi: 10.1016/j.thorsurg.2012.10.009.
  28. Feller-Kopman D.Therapeutic thoracentesis: the role of ultrasound and pleural manometry. Curr Opin Pulm Med. 2007;13(4):312-8.
  29. Nam HS. Malignant pleural effusion: medical approaches for diagnosis and management. Tuberc Respir Dis (Seoul). 2014;76(5):211-7. doi: 10.4046/trd.2014.76.5.211.
  30. Agarwal R, Paul AS, Aggarwal AN, Gupta D, Jindal SK. A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis. Respirology. 2011;16(7):1064-9. doi: 10.1111/j.1440-1843.2011.01999.x.
  31. Kishi K, Homma S, Sakamoto S, Kawabata M, Tsuboi E, Nakata K, Yoshimura K. Efficacious pleurodesis with OK-432 and doxorubicin against malignant pleural effusions. Eur Respir J. 2004;24(2):263-6.
  32. Ren S, Terman DS, Bohach G, Silvers A, Hansen C, Colt H, Sahn SA. Intrapleural staphylococcal superantigen induces resolution of malignant pleural effusions and a survival benefit in non-small cell lung cancer. Chest. 2004;126(5):1529–39.
  33. Ukale V, Agrenius V, Hillerdal G, Mohlkert D, Widström O. Pleurodesis in recurrent pleural effusions: a randomized comparison of a classical and a currently popular drug. Lung Cancer. 2004;43(3):323–8.
  34. Thomas R, Francis R, Davies HE, Lee YC. Interventional therapies for malignant pleural effusions: the present and the future. Respirology. 2014;19(6):809-22. doi: 10.1111/resp.12328.
  35. Bethune N. Pleural poudrage: new technique for the deliberate production of pleural adhesion as preliminary to lobectomy. J Thorac Surg. 1935;4:251.
  36. Janssen JP, Collier G, Astoul P, Tassi GF, Noppen M, Rodriguez-Panadero F, et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet. 2007;369(9572):1535-1539. doi: 10.1016/S0140-6736(07)60708-9.
  37. Maskell NA, Lee YC, Gleeson FV, Hedley EL, Pengelly G, Davies RJ. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004;170(4):377-82.
  38. Dresler CM, Olak J, Herndon JE 2nd, Richards WG, Scalzetti E, Fleishman SB, et al.; Cooperative Groups Cancer and Leukemia 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 sclerosis for malignant pleural effusion. Chest. 2005 Mar;127(3):909-15.
  39. Terra RM, Junqueira JJM, Teixeira LR, Vargas FS, Pêgo-Fernandes PM, Jatene FB. Is full postpleurodesis lung expansion a determinant of a successful outcome after talc pleurodesis? Chest. 2009;136(2):361-368. doi: 10.1378/chest.08-2448.
  40. Yim AP, Chan AT, Lee TW, Wan IY, Ho JK. Thoracoscopic talc insufflation versus talc slurry for symptomatic malignant pleural effusion. Ann Thorac Surg. 1996;62(6):1655-8.
  41. Rahman NM, Davies HE, Salzberg M, Truog P, Midgely R, Kerr D, et al. Use of lipoteichoic acid-T for pleurodesis in malignant pleural effusion: a phase I toxicity and dose-escalation study. Lancet Oncol. 2008;9(10):946-52. doi: 10.1016/S1470-2045(08)70205-5.
  42. Xia H, Wang XJ, Zhou Q, Shi HZ, Tong ZH. Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis. PLoS One. 2014;9(1):e87060. doi: 10.1371/journal.pone.0087060.
  43. Zhestkov KG, Iaduta RT. [The role and place of talc in malignant pleuritis management (literature review)]. Pirogov Russian Journal of Surgery. 2016;(1):40-44. [Article in Russian].
  44. Clive AO, Bhatnagar R, Psallidas I, Maskell NA. Individualised management of malignant pleural effusion. Lancet Respir Med. 2015;3(7):505-6. doi: 10.1016/S2213-2600(15)00183-6.
  45. Van Meter ME, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med. 2011;26(1):70-6. doi: 10.1007/s11606-010-1472-0.
  46. Putnam JB Jr, Walsh GL, Swisher SG, Roth JA, Suell DM, Vaporciyan AA, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg. 2000;69(2):369-75.
  47. Bhatnagar R, Kahan BC, Morley AJ, Keenan EK, Miller RF, Rahman NM, Maskell NA. The efficacy of indwelling pleural catheter placement versus placement plus talc sclerosant in patients with malignant pleural effusions managed exclusively as outpatients (IPC-PLUS): study protocol for a randomised controlled trial. Trials. 2015;16:48. doi: 10.1186/s13063-015-0563-y.
  48. Fysh ETH, Tremblay A, Feller-Kopman D, Mishra EK, Slade M, Garske L, et al. Clinical outcomes of indwelling pleural catheter-related pleural infections: an international multicenter study. Chest. 2013;144(5):1597-1602. doi: 10.1378/chest.12-3103.
  49. Plaksin SA, Farshatova LI. A method for the treatment of exudative pleurisy. Patent for Invention RUS No. 2666401. Application No. 2017122884 dated 06/28/2017. Publ. 09/07/2018; bulletin No. 25.

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Received December 23, 2019.
Accepted January 20, 2020.
©2020 International Medical Research and Development Corporation.