Pleurodesis for malignant pleural effusions

Shaw, Paul; Agarwal, Roshan

doi:10.1002/14651858.cd002916.pub3

Cited by 21 publications

(5 citation statements)

References 42 publications

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“…The efficacy of talc in the control of MPE was found to be superior to that of bleomycin and mitoxantrone in our study. The frequency of successful pleurodesis with the non-graded talc and graded talc was similar, which is in accordance with previous studies (1,10,11,25). We found no significant differences in the incidence of side effects with different agents.…”

Section: Discussionsupporting

confidence: 92%

Systemic Inflammatory Response to Different Sclerosing Agents as a Predictor of Pleurodesis Outcome

Zablockis

Danila

Gruslys

et al. 2021

In Vivo

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Background/Aim: The objectives of this study were to evaluate systemic inflammation using different sclerosing agents and to estimate the prediction of systemic inflammation for the efficacy of pleurodesis. Patients and Methods: Ninetysix patients with recurrent and symptomatic malignant pleural effusion were enrolled in this retrospective study. We used serum C-reactive protein (CRP) levels, serum leukocyte counts and neutrophil-to-lymphocyte ratios (NLRs) as parameters of systemic inflammatory reactions. Evaluations of these parameters were performed before and 24 h after pleurodesis. Results: Pleurodesis was successful in 81 (84.4%) patients. The non-graded talc induced the highest changes in serum CRP levels, total white blood cell and neutrophil counts compared to other agents, while mitoxantrone induced the lowest. Graded talc and bleomycin induced the same levels of changes in serum CRP levels and serum leukocyte counts. The change in serum NLR was the same for all agent groups. Logistic regression confirmed that a change in serum CRP levels [odds ratio (OR)=0.92, p=0.002] and previous chemotherapy (OR=3.31, p=0.012) were independent predictors of pleurodesis efficacy. Conclusion: Pleurodesis agents induced a systemic inflammatory response at different levels. The change in serum CRP levels could be useful for predicting the success of pleurodesis.Approximately half of all patients with metastatic cancer develop malignant pleural effusion (MPE), which is likely to lead to a significant reduction in their quality of life, secondary to symptoms such as dyspnoea and cough (1). The main goals of MPE treatment are to decrease symptoms and improve quality of life (2). Pleurodesis with chemical agents is the most commonly used treatment for MPE (3). Talc is the most frequently used sclerosing agent (4). Nevertheless, talc pleurodesis can manifest some severe complications, such as hypoxia and acute respiratory distress syndrome (5-9). These complications are less frequent after the use of talc with large particles (10-13). Other agents, such as tetracycline derivates, silver nitrate, povidone-iodine, mitoxantrone, doxycycline and bleomycin have also been used, with variable efficacy and safety (14). The search for the most effective and safe agent for chemical pleurodesis is ongoing (15).Pleurodesis involves the induction of acute pleural inflammation, which, if sufficiently intense, progresses to pleural fibrosis that obliterates the pleural cavity and prevents the reaccumulation of fluid ( 16). The inflammatory mechanisms involved in this process are not yet fully understood. The manifested inflammatory reaction can be divided into a systemic and local response. The intensity of inflammatory activity in the pleural cavity may predict the efficacy of pleurodesis (17). However, there is a lack of research comparing systemic inflammation induced by different sclerosing agents.The objectives of this study were to evaluate the systemic inflammation induced by different sclerosing agents in patients with MPE and to ...

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Section: Discussionsupporting

confidence: 92%

Systemic Inflammatory Response to Different Sclerosing Agents as a Predictor of Pleurodesis Outcome

Zablockis

Danila

Gruslys

et al. 2021

In Vivo

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“…MPE tend to recur rapidly after an initial thoracentesis in most patients. [ 1 , 2 ] Reported median survival in patients with MPE from various malignancies ranges from 4 to 7 months. [ 3 – 5 ] The management of these patients is 2-fold, one targeted at the cancer itself such as chemotherapy, radiotherapy, or tyrosine kinase inhibitor (TKI), and the other targeted at the drainage and prevention of reaccumulation of pleural effusion with tunneled pleural catheter, chemical pleurodesis, pleurectomy, or pleuroperitoneal shunt.…”

Section: Introductionmentioning

confidence: 99%

Pleural LDH as a prognostic marker in adenocarcinoma lung with malignant pleural effusion

Verma¹,

Phua²,

Sim³

et al. 2016

Medicine

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To study the performance of serum and pleural lactate dehydrogenase (LDH) level in predicting survival in patients with adenocarcinoma lung presenting with malignant pleural effusions (MPE) at initial diagnosis.Retrospective cohort study of the patient hospitalized for adenocarcinoma lung with MPE in year 2012.Univariate analyses showed lower pleural fluid LDH 667 (313–967) versus 971 (214–3800), P = 0.04, female gender 9 (100%) versus 27 (41.5%), P = 0.009, never smoking status 9 (100%) versus 36 (55.3%), P = 0.009, and epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy 8 (89%) versus 26 (40%), P = 0.009 to correlate with survival of more than 1.7 year versus less than 1.7 year. In multivariate analysis, low pleural fluid LDH and female gender maintained significance. The pleural LDH level of ≤1500 and >1500 U/L discriminated significantly (P = 0.009) between survival.High pleural LDH (>1500 IU/L) predicts shorter survival (less than a year) in patients with adenocarcinoma lung presenting with MPE at the time of initial diagnosis. This marker may be clinically applied for selecting therapeutic modality directed at prevention of reaccumulation of MPE. Patients with low pleural LDH may be considered suitable for measures that provide more sustained effect on prevention of reaccumulation such as chemical pleurodesis or tunneled pleural catheter.

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“…Combination of two methods allowed carry out RFA pleurodesis on parietal pleura in patients with small metastases (1-2 mm. This type of pleurodesis is more effective than the earlier known [12][13][14][15][16][17] because it allows carry out metastasectomy.…”

Section: Discussion Of the Results Of Researchmentioning

confidence: 99%

The Use of Radio-Frequency Ablation in the Treatment of Malignant Tumors of Lungs and Pleura

Severgin

Prohoda²,

Prohoda

2016

EUREKA: Health Sciences

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Aim of the work. Analysis of the possibilities of the different methods of RFA of lung and pleura tumors. Material and methods. There were considered the different methods of radio-frequency ablations using FOTEK-150 apparatus in 186 patients with the malignant tumors of lungs and pleura.Results. In the result of use of the different methods of radio-frequency ablation the direct positive effect was attained in 91 % of observations. The complications were observed in 9 % of patients. This method must be used for patients with the malignant tumors of lungs and pleura when the radical surgical treatment is impossible.Conclusions. The radio-frequency ablation can be used as a palliative method of treatment of the malignant tumors of lungs and pleura.

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Pleurodesis for malignant pleural effusions

Abstract: The editorial group responsible for this previously published document have withdrawn it from publication.

Cited by 21 publications

References 42 publications

Systemic Inflammatory Response to Different Sclerosing Agents as a Predictor of Pleurodesis Outcome

Systemic Inflammatory Response to Different Sclerosing Agents as a Predictor of Pleurodesis Outcome

Pleural LDH as a prognostic marker in adenocarcinoma lung with malignant pleural effusion

The Use of Radio-Frequency Ablation in the Treatment of Malignant Tumors of Lungs and Pleura

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