Abstract
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.
Similar content being viewed by others
References
Marel M, Zrustova M, Stasny B, et al. The incidence of pleural effusion in a well-defined region. Epidemiologic study in central Bohemia. Chest. 1993;104:1486–1489.
Antony VB, Loddenkemper R, Astoul P, et al. Management of malignant pleural effusions. Am J Respir Crit Care Med. 2000;162:1987–2001.
Putnam JB Jr, Walsh GL, Swisher SG, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg. 2000;69:369–375.
Rodriguez-Panadero F, Janssen JP, Astoul P. Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur Respir J. 2006;28:409–422.
Shannon VR, Eapen GA, Jimenez CA, et al. Respiratory complications. In: Kufe DW, Blast Jr RC, Hait WN, et al., eds. Cancer Medicine 7. 7th edition. Philadelphia, PA, USA: BC Decker Inc; 2006:2150–2173.
Sahn SA. Malignancy metastatic to the pleura. Clin Chest Med. 1998;19:351–361.
Sahn SA. Pleural diseases related to metastatic malignancies. Eur Respir J. 1997;10:1907–1901.
Meyer PC. Metastatic carcinoma of the pleura. Thorax. 1966;21;437–443.
Light RW, Hamm H. Malignant pleural effusion: would the real cause please stand up? Eur Respir J. 1997;10:1701–1702.
Chernow B, Sahn SA. Carcinomatous involvement of the pleura: an analysis of 96 patients. Am J Med. 1977;63:695–702.
Zebrowski BK, Yano S, Liu W, et al. Vascular endothelial growth factor levels and induction of permeability in malignant pleural effusions. Clin Cancer Res. 1999;5:3364–3368.
Yeh HH, Lai WW, Chen HH, et al. Autocrine IL-6-induced Stat3 activation contributes to the pathogenesis of lung adenocarcinoma and malignant pleural effusion Oncogene. 2006;25:4300–4309.
Heffner JE, Klein JS, Hampson C. Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 2010;137:467–479.
Porcel JM, Alvarez M, Salud A, Vives M. Should a cytologic study be ordered in transudative pleural effusions? Chest. 1999;116:1836–1837.
Ashchi M, Golish J, Eng P, O’Donovan P. Transudative malignant pleural effusions: prevalence and mechanisms. South Med J. 1998;91:23–26
Abouzgheib W, Bartter T, Dagher H, Pratter M, Klump W. A prospective study of the volume of pleural fluid required for accurate diagnosis of malignant pleural effusion. Chest. 2009;135:999–1001.
Swiderek J, Morcos S, Donthireddy V, et al. Prospective study to determine the volume of pleural fluid required to diagnose malignancy. Chest. 2010;137:68–73.
Davies HE, Sadler RS, Bielsa S, et al. Clinical impact and reliability of pleural fluid mesothelin in undiagnosed pleural effusions. Am J Respir Crit Care Med. 2009;180:437–444.
Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med. 1991;114:271–277.
Ferrer J, Roldán J, Teixidor J, Pallisa E, Gich I, Morell F. Predictors of pleural malignancy in patients with pleural effusion undergoing thoracoscopy. Chest. 2005;127:1017–1022.
Bielsa S, Martin-Juan J, Porcel JM, Rodriguez-Panadero F. Diagnostic and prognostic implications of pleural adhesions in malignant effusions. J Thorac Oncol. 2008;3:1251–1256.
Jones PW, Moyers JP, Rogers JT Ultrasound-guided thoracentesis: is it a safer method? Chest. 2003;123:418–423.
Feller-Kopman D, Berkowitz D, Boiselle P, Ernst A. Large-volume thoracentesis and the risk of reexpansion pulmonary edema. Ann Thorac Surg. 2007;84:1656–1661.
Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med. 2010;170:332–339.
Neragi-Miandoab S. Malignant pleural effusion, current and evolving approaches for its diagnosis and management. Lung Cancer. 2006;54:1–9.
Musani A, Haas A, Seijo L, Wilby M, Sterman D. Outpatient management of malignant pleural effusions with small-bore, tunneled pleural catheters. Respiration. 2004;71:559–566.
Putnam JB, Walsh GL, Swisher SG, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg. 2000;69:369–375.
Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest. 2006;129:362–368.
Warren WH, Kalimi R, Khodadadian LM, Kim AW. Management of malignant pleural effusions using the Pleur(x) catheter. Ann Thorac Surg. 2008;85:1049–1055.
Tremblay A, Mason C, Michaud G. Use of tunnelled catheters for malignant pleural effusions in patients fit for pleurodesis. Eur Respir J. 2007;30:759–762.
Jimenez CA, Ozcakar B, Morice RC, et al. Pleurodesis after intrapleural catheter insertion is an independent factor for overall survival in patients with malignant pleural effusions. Eur Respir J. 2009;34(Suppl. 53):299.
Sterman DH, Recio A, Carroll RG, et al. A phase I clinical trial of single-dose intrapleural IFN-beta gene transfer for malignant pleural mesothelioma and metastatic pleural effusions: high rate of antitumor immune responses. Clin Cancer Res. 2007;13:4456–4466.
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;119:1641–1646.
Jimenez CA, Mhatre AD, Martinez CH, Eapen GA, Onn A, Morice RC. Management of recurrent chylothorax in patients with cancer. Chest. 2007;132:1584–1590.
Sartori S, Tombesi P, Tassinari D, et al. Sonographically guided small-bore chest tubes and sonographic monitoring for rapid sclerotherapy of recurrent malignant pleural effusions. J Ultrasound Med. 2004;23:1171–1176.
Spiegler PA, Hurewitz AN, Groth ML. Rapid pleurodesis for malignant pleural effusions. Chest. 2003;123:1895–1898.
Tan C, Sedrakyan A, Browne J, et al. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardio-Thorac Surg. 2006;29:829–838.
Casal RF, Eapen GA, Morice RC, Jimenez CA. Medical thoracoscopy. Curr Opin Pulm Med. 2009;15:313–320.
Viskum K, Enk B. Complications of thoracoscopy. Poumon Coeur. 1981;37:25–28.
Wilson WC, Benumof JL. Anesthesia for thoracic surgery. In: Miller RD, Eriksson LI et al., eds. Miller’s Anesthesia. 7th edition. Morristown, NJ, USA: Churchill Livingstone; 2009:chapter 49.
Hill SE, Keller RA, Stafford-Smith M, et al. Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures. Anesthesiology. 2006;104:1047–1053.
Pompeo E. Awake operative videothoracoscopic pulmonary resections. Thorac Surg Clin. 2008;18:311–320.
Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev. 2004;(1):CD002916.
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;62:1655–1658.
Manes N, Rodriguez-Panadero F, Bravo JL, Hernandez H, Alix A. Talc pleurodesis. Prospective and randomised study. Clinical follow-up. Chest. 2000;118:131.
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;127:909–915.
Campos JR, Werebe EC, Vargas FS, Jatene FB, Light RW. Respiratory failure due to insufflated talc. Lancet. 1997;349:251–252.
Rehse DH, Aye RW, Florence MG. Respiratory failure following talc pleurodesis. Am J Surg. 1999;177:437–440.
Maskell NA, Lee YCG, Gleeson FV, et al. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004;170:377–382.
Julius PJ, Gareth C, Phillippe A, et al. Safety of pleurodesis with talc poudarage in malignant pleural effusion: a prospective cohort study. Lancet. 2007;369:1535–1539.
Light RW, Cheng D-S, Lee YC, et al. A single intrapleural injection of transforming growth factor-2 produces excellent pleurodesis in rabbits. Am J Respir Crit Care Med. 2000;162:98–104.
Lee YCG, Teixeira LR, Devin CJ, et al. Transforming growth factor-beta(2) induces pleurodesis significantly faster than talc. Am J Respir Crit Care Med. 2001;163:640–644.
Dong M, Li X, Hong LJ, et al. Advanced malignant pleural or peritoneal effusion in patients treated with recombinant adenovirus p53 injection plus cisplatin. J Int Med Res. 2008;36:1273–1278.
Rahman NM, Davies HE, Salzberg M, et al. Use of lipoteichoic acid-T for pleurodesis in malignant pleural effusion: a phase I toxicity and doseescalation study. Lancet Oncol. 2008;9:946–952.
Crnjac A, Sok M, Kamenik M. Impact of pleural effusion pH on the efficacy of thoracoscopic mechanical pleurodesis in patients with breast carcinoma Eur J Cardiothorac Surg. 2004;26:432–436.
Reich H, Beattie EJ, Harvey JC. Pleuroperitoneal shunt for malignant pleural effusions: a one-year experience. Semin Surg Oncol. 1993;9:160–162.
Lee KA, Harvey JC, Reich H, et al. Management of malignant pleural effusions with pleuroperitoneal shunting. J Am Coll Surg. 1994;178:586–588.
Burrows CM, Mathews WC, Colt HG. Predicting survival in patients with recurrent symptomatic malignant pleural effusions: an assessment of the prognostic values of physiologic, morphologic, and quality of life measures of extent of disease. Chest. 2000;117:73–78.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Uzbeck, M.H., Almeida, F.A., Sarkiss, M.G. et al. Management of malignant pleural effusions. Adv Therapy 27, 334–347 (2010). https://doi.org/10.1007/S12325-010-0031-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/S12325-010-0031-8