Control of pleural effusions in patients with breast cancer a randomized trial

Fentiman, Ian S.; Rubens, Robert; Hayward, John

doi:10.1002/1097-0142(19830815)52:4<737::aid-cncr2820520428>3.0.co;2-8

Cited by 75 publications

(34 citation statements)

References 8 publications

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“…The response rate to ST for breast cancer is midway between that for small cell lung cancer and nonsmall cell lung cancer. Some studies have reported that control of pleural effusion was not significantly different between ST and P-ST [5][6][7]. Based on these studies, breast cancer patients with MPE are currently administered ST as the first choice for treatment.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of pleurodesis for malignant pleural effusions in breast cancer patients

Hirata¹,

Yonemori

Hirakawa³

et al. 2011

Eur Respir J

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This study retrospectively compared long-term outcomes between two groups of breast cancer patients with malignant pleural effusion (MPE): those receiving only systemic therapy (ST) and those receiving ST following initial pleurodesis (P-ST).We identified 180 breast cancer patients from the National Cancer Center Hospital (Tokyo, Japan) database who had received ST and P-ST as an initial treatment for MPE between 1997 and 2008 for study inclusion. Pleural progression-free survival (PPFS) was defined as the time from ST in the ST group and from pleurodesis in the P-ST group to the first observation of pleural progression or death from any cause.Of the 180 patients, 78 received ST and 102 received P-ST after MPE diagnosis. Median duration of follow-up was 12.7 months (range 0.9-80.1 months). Median PPFS for the ST group and the P-ST group was 4.1 and 8.5 months, respectively. The difference in PPFS between the two groups was statistically significant (p,0.001) and the hazard ratio after adjusting for prognostic factors in the P-ST group relative to the ST group was 0.24.Our results suggest that the efficacy of P-ST may be superior to that of ST alone with respect to local control of pleural effusions in breast cancer patients.

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Section: Discussionmentioning

confidence: 99%

“…These guidelines are based on retrospective studies conducted in the 1970s and 1980s that reported that the control of pleural effusion did not significantly differ among local, systemic and combined therapies [5][6][7]. Systemic therapy (ST) has traditionally been the mainstay of treatment for metastatic breast cancer with or without pleurodesis.…”

mentioning

confidence: 99%

Efficacy of pleurodesis for malignant pleural effusions in breast cancer patients

Hirata¹,

Yonemori

Hirakawa³

et al. 2011

Eur Respir J

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“…Furthermore, successful pleurodesis is less likely if the pleural malignancy is advanced. Therefore, some clinicians advocate that pleurodesis be attempted sooner rather than later during the course of the disease [3,4]. We currently agree with this position, in order to avoid attempting pleural symphysis when the effusion is rapidly recurrent and the general condition of the patient has deteriorated.…”

Section: Is the Effusion Recurrent?mentioning

confidence: 98%

Pleurodesis: state of the art

Rodríguez-Panadero

Antony²

1997

Eur Respir J

169

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Pleurodesis aims to achieve a symphysis between parietal and visceral pleural surfaces, in order to prevent accumulation of fluid or air in the pleural space. Its major indications are malignant effusions and pneumothorax, and a reexpandable lung is essential for the success of the technique. Moreover, expectation of a reasonably long survival is important before attempting pleurodesis.A successful lung re-expansion is unlikely if the pleural pressure falls more than 20 cmH 2 O·L -1 of fluid removed, because there is a central bronchial obstruction or the lung is trapped by tumour and/or fibrin. Pleural fluid pH (<7.20) is a good indicator of the presence of trapped lung; moreover, a successful pleurodesis is less likely when pH is low, and this parameter is also a good predictor for survival of the patients.Among the many sclerosing agents that have been used for pleurodesis, talc has achieved the best results, with an average success rate of approximately 90%. The cellular and biochemical mechanisms involved in pleurodesis may be specific to the agent used, however, they may all follow a common final pathway leading to activation of the pleural coagulation cascade, the appearance of fibrin networks, and the proliferation of fibroblasts. The details of these mechanisms are still unclear and need to be further elaborated. Eur Respir J 1997; 10: 1648-1654 The aim of pleurodesis is to achieve a symphysis between visceral and parietal pleural layers, in order to prevent accumulation of either air or fluid in the pleural space. Its main indications are malignant pleural effusions and pneumothorax. The choice of the right technique, sclerosing agent to be applied, criteria for selection of patients and evaluation of results are important and controversial issues. Furthermore, there is little information about the mechanisms that lead to pleural symphysis or the factors that influence the outcome of pleurodesis. Pleurodesis in malignant effusionsRecurrent effusions of malignant origin are by far the most common indication for pleurodesis in clinical practice. This is because there is a lack of effective antitumoral treatment at later stages of the disease, and because palliative measures are necessary to improve symptoms related to the pleural effusion. Repeated thoracenteses are not usually suitable, since they may be troublesome to the patient and provoke important protein loss (about 40 g·L -1 of pleural fluid that is withdrawn), with infection of the pleural space as an added risk.

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“…Pleural metastases are common in the course of breast cancer, affecting 10-50% of breast cancer patients [1][2][3]. This pleural involvement may be the first and only manifestation of recurrent disease in 20-40% of these patients [1,2,4].…”

mentioning

confidence: 99%

Medical thoracoscopy: hormone receptor content in pleural metastases due to breast cancer

Schwarz

Lübbert²,

Rahn³

et al. 2004

European Respiratory Journal

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Pleural metastases are common in the course of breast cancer, but, to date, the role of oestrogen receptor (OR) and progesterone receptor (PgR) content in metastatic tissue has been poorly evaluated.A series of 50 consecutive patients with a history of breast cancer (median age 64 yrs, range 40-86 yrs), which presented with pleural effusion and therefore underwent medical thoracoscopy, was analysed. Metastatic pleural involvement was histologically confirmed in all patients. The hormone receptor status of the pleural metastases was investigated using the immunohistochemical method in 49 and the biochemical method in 31 cases. The immunohistochemical test was performed using monoclonal antibodies. Biochemical analysis was performed on specimens quick-frozen in liquid nitrogen. OR and PgR were measured with the dextran-coated charcoal assay and Scatchard analysis.Immunohistochemical analysis yielded 29 OR-positive and 25 PgR-positive cases and biochemical analysis yielded 16 OR-positive and four PgR-positive cases, sometimes discrepant to hormone status of the primary breast cancer. Using a semiquantitative immunoreactive score, there was a significant association between receptor positivity and survival, but only for PgR positivity.Immunohistochemical and biochemical detection of hormone receptors (oestrogen and progesterone) in pleural metastases of breast cancer is feasible based on medical thoracoscopy as the method of choice, by which sufficient specimens may be obtained. The receptor status may enable a decision on antihormonal treatment. Whether a positive receptor status in pleural metastatic tissue is associated with a better prognosis remains to be confirmed.

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Control of pleural effusions in patients with breast cancer a randomized trial

Cited by 75 publications

References 8 publications

Efficacy of pleurodesis for malignant pleural effusions in breast cancer patients

Efficacy of pleurodesis for malignant pleural effusions in breast cancer patients

Pleurodesis: state of the art

Medical thoracoscopy: hormone receptor content in pleural metastases due to breast cancer

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