An update in the management of malignant pleural effusion

Abstract

Malignant pleural effusion (MPE) usually presents in the disseminated and advanced stage of malignancy. Dyspnea is the debilitating symptom which needs palliation in these patients. Various modalities are available in the management of MPE. Careful consideration of the patient's expected survival and quality of life is needed when deciding the optimum treatment modality in such patients. In this article, different modalities of the palliative management of MPE are discussed with an attempt to derive a treatment algorithm for the management of MPE.

Management of dyspnea and respiratory insufficiency as a main palliayive care in malignant pleural effusions

“…It must be borne in mind that the survival of these patients usually varies within 3-12 months. (1,4) These are palliative surgical procedures allowing a comparatively decent remaining life of patients with advanced malignant pleural effusions, relieving them of the torturing dyspnea symptoms and, at the same time, relieving the thoracic surgeon of the necessity to constantly evacuate the effusion. For …”

“…(1,3,4) Besides managing the process of the primary disease with chemotherapy, surgery or radiation therapy, the main concern in patients with MPE is the palliative treatment of dyspnea. (1) The issues referring to the MPE palliative treatment shall be discussed in greater detail in the present study. Dyspnea palliative treatment in patients with MPE is managed by the process of removing the effusion from the pleural membrane area through the least invasive ____________________________ *Correspondence to: Valchev D., Clinic of Thoracic Surgery, Prof. Dr. St. Kirkovich AD Multispeciality Hospital for Active TreatmentStara Zagora, Bulgaria; e-mail: dg_valchev@abv.bg procedure for the longest possible period within the patient's limited survival period.…”

“…The pleural catheter placement and the VATS procedure can be followed by pleurodesis. (1,5) The scope of the treatment conducted depends mainly on two factors, i.e. the severity of the symptoms caused by MPE and the patient's performance status.…”

“…(1,2) Treatment goals for these patients should focus on the relief or elimination of dyspnea, restoration and preservation of the patients' ability to care for themselves and be physically active, minimization or elimination of hospitalizations, as well efficient use of palliative care. (1,3,4) Besides managing the process of the primary disease with chemotherapy, surgery or radiation therapy, the main concern in patients with MPE is the palliative treatment of dyspnea. (1) The issues referring to the MPE palliative treatment shall be discussed in greater detail in the present study.…”

Indikationen für thoraxchirurgische Interventionen

“…Im letzteren Fall dient die Drainage der vollständigen Ableitung des Pleuraergusses mit nachfolgender CT zur Überprüfung der definitiven Ausdehnungsfähigkeit der Lunge. Bei alleiniger Drainagetherapie ist die Rezidivrate des malignen Pleuraergusses mit > 80% innerhalb von 30 Tagen beschrieben [24,25].…”