Pleural effusions as markers of mortality and disease severity

DeBiasi, Erin M.; Puchalski, Jonathan

doi:10.1097/mcp.0000000000000278

Cited by 22 publications

(22 citation statements)

References 47 publications

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“…The management of pleural effusions depends upon the underlying etiology [ 42 ]. When associated with disease states, pleural effusions, both benign effusions and cancer-associated, are correlated with high mortality [ 43 , 44 ]. Pleural effusions are a significant risk factor for the treatment of thoracic cancers [ 45 ], and the presence of pleural effusions with lung cancer can preclude curative surgery [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Thoracic radiation-induced pleural effusion and risk factors in patients with lung cancer

et al. 2017

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The risk factors and potential practice implications of radiation-induced pleural effusion (RIPE) are undefined. This study examined lung cancer patients treated with thoracic radiation therapy (TRT) having follow-up computed tomography (CT) or 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. Increased volumes of pleural effusion after TRT without evidence of tumor progression was considered RIPE. Parameters of lung dose-volume histogram including percent volumes irradiated with 5-55 Gy (V5-V55) and mean lung dose (MLD) were analyzed by receiver operating characteristic analysis. Clinical and treatment-related risk factors were detected by univariate and multivariate analyses. 175 out of 806 patients receiving TRT with post-treatment imaging were included. 51 patients (24.9%) developed RIPE; 40 had symptomatic RIPE including chest pain (47.1%), cough (23.5%) and dyspnea (35.3%). Female (OR = 0.380, 95% CI: 0.156–0.926, p = 0.033) and Caucasian race (OR = 3.519, 95% CI: 1.327–9.336, p = 0.011) were significantly associated with lower risk of RIPE. Stage and concurrent chemotherapy had borderline significance (OR = 1.665, p = 0.069 and OR = 2.580, p = 0.080, respectively) for RIPE. Patients with RIPE had significantly higher whole lung V5-V40, V50 and MLD. V5 remained as a significant predictive factor for RIPE and symptomatic RIPE (p = 0.007 and 0.022) after adjusting for race, gender and histology. To include, the incidence of RIPE is notable. Whole lung V5 appeared to be the most significant independent risk factor for symptomatic RIPE.

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Section: Discussionmentioning

confidence: 99%

Thoracic radiation-induced pleural effusion and risk factors in patients with lung cancer

et al. 2017

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“…[1][2][3][4] Management following MPE detection is therefore palliative, with treatment goals shifted from potentially curative to symptom-based. 8 Cytological analysis of pleural fluid is often the firstline diagnostic test performed after an effusion is detected. 6,7 Recent data suggest that pleural effusion due to a benign cause, such as a congestive heart failure or renal failure, is also a poor prognostic sign that has so far been underrecognised.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Recent data suggest that pleural effusion due to a benign cause, such as a congestive heart failure or renal failure, is also a poor prognostic sign that has so far been underrecognised. 8 Cytological analysis of pleural fluid is often the firstline diagnostic test performed after an effusion is detected. Biochemical analysis is also routine, but at best can only add weight to the suspicion of malignancy in the given clinical context.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience

Loveland

Christie

Hammerschlag

et al. 2018

Internal Medicine Journal

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“…Both management and treatment options for pleural metastasis (PM) and malignant pleural effusion (MPE) are continuously evolving, as seen by the introduction of tunneled pleural catheters, chemical pleurodesis and combined procedures (1)(2)(3). PM is a common manifestation of several tumor entities exhibiting a poor prognosis (4)(5)(6). The treatment of PM is often interdisciplinary and includes oncologist, pulmonologists, surgeons, anesthesiologists and other specialists.…”

Section: Introductionmentioning

confidence: 99%

Intrathoracic aerosol chemotherapy via spray‑catheter

et al. 2020

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Pressurized intrathoracic aerosol chemotherapy (PITAC) has been introduced to the clinical setting as a novel treatment option for pleural metastasis (PM). For decades the therapeutic application of aerosols was limited to intrabronchial delivery. However, present studies suggest performing PITAC on patients with PM and malignant pleural effusion. Using an established ex vivo swine model, the present study aimed to introduce a facilitated intrathoracic chemoaerosol application via spray-catheter. Using an ex-vivo model of 3 postmortem swine, the feasibility of intrathoracic aerosol chemotherapy (ITC) with doxorubicin using a spray-catheter was evaluated in a normal pressure environment. Following thoracotomy, the spray-catheter was inserted via trocar. Tissue samples were retrieved and further analyzed by fluorescence microscopy to detect doxorubicin contact. Our data demonstrated that the application of ITC was technically feasible and did not exhibit any significant obstacles. By making a minimally invasive thoracotomy incision it was possible to create an adequate pneumothorax without the need of a double-lumen tube or intubation. ITC did not require the creation of a pressurized environment. Tissue samples revealed doxorubicin contact within the pleura. In conclusion, ITC is a fast and feasible procedure that could possibly be administered via bedside application, therefore eliminating the need of an operating room and surgical staff. However, further studies are required to evaluate the safety of patients and physicians regarding this novel applicational modality. Nevertheless, the present study demonstrated that ITC may potentially be applied at bedside, an option that is particularly important for patients who do not qualify for PITAC procedures.

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Pleural effusions as markers of mortality and disease severity

Abstract: Both benign and MPEs are associated with high mortality. Prognostic models and studies comparing treatment modality effect on survival will continue to guide management of these complex problems.

Cited by 22 publications

References 47 publications

Thoracic radiation-induced pleural effusion and risk factors in patients with lung cancer

Thoracic radiation-induced pleural effusion and risk factors in patients with lung cancer

Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience

Intrathoracic aerosol chemotherapy via spray‑catheter

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