Contemporary best practice in the management of malignant pleural effusion

Malignant pleural effusion (MPE) affects more than 1 million people globally. There is a dearth of evidence on the therapeutic approach to MPE, and not surprisingly a high degree of variability in the management thereof. We aimed to provide practicing clinicians with an overview of the current evide...

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Bibliographic Details
Published in:Therapeutic Advances in Respiratory Disease 2018-01, Vol.12, p.1753466618785098-1753466618785098
Main Authors: Koegelenberg, Coenraad F.N., Shaw, Jane A., Irusen, Elvis M., Lee, Y. C. Gary
Format: Article
Language:English
Subjects:
Drainage - adverse effects
Drainage - methods
Humans
Medical prognosis
Palliative Care - methods
Patients
Pleural Effusion, Malignant - diagnostic imaging
Pleural Effusion, Malignant - epidemiology
Pleural Effusion, Malignant - therapy
Pleurodesis - adverse effects
Pleurodesis - methods
Recurrence
Retreatment
Review
Risk Factors
Thoracentesis - adverse effects
Thoracentesis - methods
Treatment Outcome
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Summary:Malignant pleural effusion (MPE) affects more than 1 million people globally. There is a dearth of evidence on the therapeutic approach to MPE, and not surprisingly a high degree of variability in the management thereof. We aimed to provide practicing clinicians with an overview of the current evidence on the management of MPE, preferentially focusing on studies that report patient-related outcomes rather than pleurodesis alone, and to provide guidance on how to approach individual cases. A pleural intervention for MPE will perforce be palliative in nature. A therapeutic thoracentesis provides immediate relief for most. It can be repeated, especially in patients with a slow rate of recurrence and a short anticipated survival. Definitive interventions, individualized according the patient’s wishes, performance status, prognosis and other considerations (including the ability of the lung to expand) should be offered to the remainder of patients. Chemical pleurodesis (achieved via intercostal drain or pleuroscopy) and indwelling pleural catheter (IPC) have equal impact on patient-based outcomes, although patients treated with IPC spend less time in hospital and have less need for repeat pleural drainage interventions. Talc slurry via IPC is an attractive recently validated option for patients who do not have a nonexpandable lung.
ISSN:1753-4666
1753-4658
1753-4666
DOI:10.1177/1753466618785098