Elsevier

Lung Cancer

Volume 50, Issue 1, October 2005, Pages 123-127
Lung Cancer

SHORT COMMUNICATION
Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter

https://doi.org/10.1016/j.lungcan.2005.05.016Get rights and content

Summary

Many patients with various forms of cancer develop sooner or later malignant pleural effusions, resulting in feelings of discomfort and reduced quality of life. Several palliative options exist, including repeated thoracocentesis and pleurodesis with a sclerosing agent. However, these “therapeutic” possibilities are not always successful and sometimes even contraindicated. Also, patients need to visit the hospital regularly or have to stay hospitalised for several days. A chronic indwelling pleural catheter could provide a simple, completely outpatient way to provide respiratory relief and improvement in quality of life in patients with malignant pleural effusions.

We evaluated retrospectively the course of 17 patients with malignant pleural effusions who were treated with a chronic indwelling pleural catheter (PleurX®). Eligible patients were selected in the years 2001–2003 from a single institution.

In 70–80% of patients, catheter use was uncomplicated and provided significant symptom relief. Mean duration of catheter use was 2.3 (range 1–6) months. Mean fluid removal was 360 (range 150–1000 cc) per 24 h in the first weeks of treatment. Infection was seen in two (12%) patients, dislocation of the catheter in three (18%). In the final analysis, catheter use was unsatisfactory in two patients (12%).

We conclude that a chronic indwelling catheter is a very useful tool in the management of recurrent malignant pleural effusions. Treatment can be accomplished completely at home, whereas complications are rare.

Introduction

Survival in patients with malignant pleural effusions (MPE) is usually poor, although it varies slightly by histology of the tumor [1] and available options for anti-tumor therapy. Also, pleural effusions seriously affect quality of life and diminish mobility in patients with a malignant disease. Therefore, several methods have been advocated to relieve dyspnea and other feelings of discomfort in patients with MPE, each with certain advantages and disadvantages. Of these, repetitive thoracocentesis is the most widely used and easiest to perform. However, the effect is mostly of short duration. A more durable effect can be achieved with pleural sclerosis with talc, tetracycline or bleomycin, although unfavorable chemical conditions of the pleural fluid, such as a pH below 7.3, often indicate a disappointing result. In patients not suitable for pleurodesis, or with recurrent MPE after pleurodesis, chronic intermittent drainage via a subcutaneous tunneled pleural catheter (PC) on an outpatient basis has been shown to relieve dyspnea effectively without serious complications [2], [3], [4].

However, the experience with chronic indwelling PC's in patients with MPE is still very limited.

We hypothesized that patients with MPE, who were considered not suitable for pleurodesis, or with recurrent MPE after pleurodesis, could well be palliated with a chronic indwelling PC. Such treatment was believed to be patient-friendly, effective and without complications. To test this hypothesis, we retrospectively evaluated the experience with the PleurX chronic indwelling pleural catheter in 17 consecutive patients from a single institution in whom pleurodesis failed or was considered unsuitable.

Section snippets

Patients

All consecutive patients from the departments of Pulmonology and Medical Oncology Erasmus MC-Daniel den Hoed Cancer Center Rotterdam with MPE who have been treated with a PleurX chronic indwelling PC in 2001 to 2003 were analyzed retrospectively. Patients with recurrent cytologically proven MPE, who were ineligible for pleurodesis, or with recurrent MPE after pleurodesis, were considered potential candidates for a PleurX catheter. Ineligibility for pleurodesis was considered if there was a

Results

From january 2001 to december 2003, 17 consecutive patients with symptomatic MPE were treated with a chronic indwelling pleural catheter. An example is shown in Fig. 2. Patients’ characteristics are listed in Table 1. Mean age was 61.7 ± 7 years. Male/female ratio was 10/7. Six patients were diagnosed with a malignant pleural mesothelioma, four with non-small-cell lung cancer, three with breast cancer, two with a melanoma, one with small-cell lung cancer, and one with esophageal cancer. All

Discussion

In this study we evaluated the use of a chronic indwelling PC in patients with symptomatic MPE and, in general, a limited life expectancy. Substantial improvement in well-being was seen in the majority of patients. Complications were rare, whereas dealing with the PC appeared to be easy, and could be performed by the patient or his/her relatives.

A limited number of studies focused on the use of a chronic indwelling PC in patients with MPE. Putnam et al. summarized their experience with 100

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