Hyperthermic intrathoracic chemotherapy for the treatment of malignant pleural effusion caused by breast and ovarian cancer: A systematic literature review and pooled analysis

Abstract

Breast and ovarian cancer account for over 30% of malignant pleural effusions (MPEs). Treatment of the metastatic disease requires control of the MPE. Even though primarily symptomatic, the treatment of the MPE can potentially affect the oncological course of the disease. The aim of this review is to analyze the effectiveness of intrathoracic chemotherapy in the treatment of MPE caused by breast and ovarian cancer. Methods: A systematic literature research was conducted up until May 2021. Studies published in English on patients undergoing either surgical or interventional intrapleural chemotherapy were included. Results: Thirteen studies with a total of 497 patients were included. Analysis was performed on 169 patients with MPE due to breast cancer and eight patients with MPE secondary to ovarian cancer. The pooled success rates of intrathoracic chemotherapy for controlling the MPE were 59.1% and 87.5%, respectively. A survival analysis was not possible with the available data. The overall toxicity of the treatment was low. Conclusions: Intrathoracic chemotherapy achieves symptomatic control of the MPE in 59.1% of patients with metastatic breast cancer and 87.5% of patients with metastatic ovarian cancer. This is inferior to other forms of surgical pleurodesis. Data from small case series and studies on intraperitoneal chemotherapy show promising results. However, formal oncological studies on the use of intrathoracic chemotherapy for metastatic breast or ovarian cancer are lacking. Further prospective pilot studies are needed to assess the therapeutic oncological effects of this treatment.

Outcome after cytoreductive surgery combined with hyperthermic intrathoracic chemotherapy in patients with secondary pleural metastases

“…showed a promising survival in patients with ovarian cancer with pleural metastases after combined abdominal and thoracic CRS ( 27 ). The use of HITOC without CRS showed to be helpful for relieving the symptoms of pleural effusion in patients with metastatic ovarian cancer ( 28 ). Nikiforchin et al.…”

Intrapleural Anticancer Therapy for Malignant Pleural Diseases: Facts or Fiction?

“…A recent meta-analysis assessed the role of intrathoracic chemotherapy for control of malignant pleural effusion secondary to breast cancer and ovarian cancer and demonstrated that it achieves symptomatic control in 59% of metastatic breast and 87% of metastatic ovarian cancer patients and was inferior to other forms of pleurodesis, especially surgical pleurodesis. 30 Thus, routine use of intrapleural chemotherapy for extrathoracic metastatic disease to the pleura is limited.…”

Malignant Pleural Effusions: Updates in Diagnosis and Management

“…Finally, a recent systematic literature review and pooled analysis by Karampinis et al demonstrated success in the use of intrathoracic chemotherapy. In their study they demonstrated that in patients with breast or ovarian cancer, intrathoracic chemotherapy was successful in reducing MPE in 59.1% and 87.5% of patients, respectively [ 57 ]. Multiple other chemical pleurodesis agents and indwelling catheters are currently in various stages of assessment at this time.…”