Catheter Tract Metastasis in Mesothelioma Patients with Indwelling Pleural Catheters: A Retrospective Cohort Study

Abstract

Background: Use of indwelling pleural catheters (IPCs) for the management of symptomatic pleural effusions in patients with mesothelioma has increased in popularity. An important concern with this approach is the potential for the development of catheter tract metastasis (CTM). Objectives: To determine the incidence of IPC-related CTM in patients with malignant pleural mesothelioma (MPM). Methods: In this single-center retrospective cohort study, patients with biopsy-confirmed MPM who had an IPC inserted between May 2006 and July 2017 were identified from a prospectively collected database. Thoracic CT scans following IPC insertion were reviewed to assess for evidence of CTM. Patients were followed until death or last documented patient encounter with a minimum of 6-month follow-up. Results: A total of 90 patients were included in the cohort. CTM was identified in 23 of 90 patients (26%). Median time from IPC insertion to CTM was 408 days (interquartile range 196–721 days). Medical thoracoscopy at the time of IPC insertion did not lead to a significantly increased odds of CTM (OR 2.30; 95% CI 0.66–7.94; p = 0.19). Incidence of CTM was not different between mesothelioma subtypes (p = 0.09). Patient-reported dyspnea scores were improved following IPC insertion in 80% of patients. Conclusions: CTM was identified in over a quarter of MPM patients when follow-up imaging was reviewed. Treating physicians should be cognizant of the possibility of CTM at the site of prior IPC.

A practical approach to the diagnosis and management of malignant pleural effusions in resource-constrained settings

“…Other complications of IPC are catheter malfunction (1.1%), obstruction (1.5%) and tract metastasis (0–26% depending on tumour type) [ 60 , 63 ]. Nondrainage may signal successful pleurodesis or indicate catheter malfunction.…”

Indwelling Pleural Catheter: Management of Complications

“…44 In the setting of IPC for MPEs, catheter tract metastases (CTMs) occur in 14 to 42% of patients with mesothelioma but it is much less common in other malignancies (0.4 to 4.6%). 16,45,46 Unlike other pleural drainages (e.g., thoracentesis) when the pleural tumor was breached on a one-off basis, IPC remains in situ and presents further ongoing risks of seedling (e.g., by fluid leaking around the pleural puncture site) and dissemination of malignant cells along the catheter tract. 22 Patients with mesothelioma have a longer median lifespan than those with MPE from metastatic cancers 47 and often may have longer duration of IPC placement and thus higher risks.…”

“…Indeed, having an IPC in situ beyond 2 months is one risk factor identified to be associated with the development of CTM. 45,46 Regular monitoring of symptoms (e.g., pain) and inspection of the IPC site and tract is important and can allow early recognition of CTM before they become symptomatic. Characteristic features of CTM can also be seen on computed tomography (CT) scan (►Fig.…”

“…Indeed, having an IPC in situ beyond 2 months is one risk factor identified to be associated with the development of CTM. 45 46…”

Catéter pleural permanente una opción para el manejo del derrame pleural maligno

“…Los datos de incidencia son variados. En una cohorte que incluyó 90 pacientes con mesotelioma, se documentó un 26% (23/90) de incidencia de siembras tumorales en el trayecto tunelizado (64), mientras que en un estudio de 107 pacientes, sólo el 10% de los casos (11/107) tuvieron metástasis en el trayecto tunelizado, identificándose que el factor de riesgo más importante es el tiempo transcurrido desde la inserción del catéter (OR, 2.495; 95% CI, 1.247 -4.993, p = .0098). En estos casos, se hizo radioterapia sobre el trayecto de inserción del catéter con buena tolerancia, poco…”