Recent Developments in the Management of Malignant Pleural Effusions: a Narrative Review
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THORACIC ONCOLOGY (J PUCHALSKI, SECTION EDITOR)
Recent Developments in the Management of Malignant Pleural Effusions: a Narrative Review Clifford E. Coile 1 & Jessie G. Harvey 1 & Michal Senitko 1,2 Accepted: 12 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of the Review The goal of this paper is to evaluate the literature published over past 3 years and emphasize the most recent updates in the diagnosis and management of malignant pleural effusions (MPE). Recent Findings The management of MPE is focused on palliation of symptoms and should take into account patient preferences and anticipated survival. Chemical pleurodesis and indwelling pleural catheters (IPC) are both definitive options for recurrent symptomatic MPE. IPC placement reduces hospitalization and can result in spontaneous pleurodesis, but these advantages must be weighed against the cost of materials and ongoing care. IPC is preferred over attempted pleurodesis in the presence of nonexpandable lung. The use of vacuum bottles during therapeutic thoracentesis is associated with increased pain and complications, and drainage via manual aspiration or to gravity is preferred. The routine use of manometry does not appear to reduce procedure-related discomfort. Summary Several new advances have been made and discovered in relation to procedural aspects of thoracentesis, diagnosis, and management of MPE. We summarized the most relevant trials and studies and discuss their application in the clinical practice. Keywords Malignant pleural effusion . Thoracentesis . Manometry . Vacuum bottles . Pleurodesis . Tunneled pleural catheter . Indwelling pleural catheter . Trapped lung
Introduction Malignant pleural effusions (MPE) are a common complication of advanced cancer and are associated with significant morbidity and cost. The diagnosis of malignant pleural effusion defines the malignancy as metastatic (stage IV) and portends a poor prognosis. Cancers of the lung and breast are the most common culprits, and overall survival is typically on the order of a few months [1]. The diagnosis of malignant pleural effusion is established by the presence of malignant cells in the pleural fluid. Once diagnosed, the management of MPE is strictly palliative in intent [1–3]. Drainage of the effusion may relieve dyspnea, This article is part of the Topical Collection on Thoracic Oncology * Michal Senitko [email protected] 1
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but the effusion is likely to recur, necessitating additional interventions, exposing the patient to additional procedurerelated risk, and often requiring hospitalization. Thus, definitive procedures that prevent the reaccumulation of pleural fluid are desirable. This has most often been accomplished via thoracostomy and chemical pleurodesis. More recently, pleuroscopy and the placement of indwelling pleural catheters (IPC) have become additional options. Whether to achieve palliation of symptoms with serial thoracentesis versus definitive interventions should be decided based on the patient’s progno
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