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Hansen PS, Graversen M, Detlefsen S, Mortensen MB. Review on treatment of pleural metastasis and malignant pleural effusion with Pressurized IntraThoracic Aerosol Chemotherapy (PITAC). Pleura Peritoneum 2024; 9:47-53. [PMID: 38948327 PMCID: PMC11211649 DOI: 10.1515/pp-2023-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/05/2024] [Indexed: 07/02/2024] Open
Abstract
Background Malignant pleural effusion (MPE) is a common and debilitating condition seen in advanced cancer disease, and life-expectancy is short. Symptoms include pain and severe shortness of breath. Current first-line treatment options include pleural drainage using catheters as well as pleurodesis. However, these treatment modalities are often inefficient and patients need repeated procedures. Pressurized IntraThoracic Aerosol Chemotherapy (PITAC) is a minimally invasive procedure, where antineoplastic agents are nebulized under pressure into the pleural space. Content We present the preliminary safety, feasibility, and response assessment data for PITAC based on a comprehensive literature review. Summary Five retrospective studies reported data on 38 PITACs in 21 patients. Data were heterogeneous and incomplete on several important aspects such as procedure, safety, local effect and long-term outcomes. PITAC seems technically feasible with a low risk of complications and may provide some reduction in MPE in selected cases. Outlook PITAC seems feasible, but prospective phase I and II studies are needed to define safety, indications, and efficacy.
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Affiliation(s)
- Pernille Schjødt Hansen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
| | - Martin Graversen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
- Department of Surgery, HPB and Upper GI Section, Odense University Hospital, Odense, Denmark
| | - Sönke Detlefsen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Michael Bau Mortensen
- Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark
- Department of Surgery, HPB and Upper GI Section, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Fjællegaard K, Petersen JK, Jensen C, Rasmussen DB, Skaarup SH, Laursen CB, Bødtger U. Pleural disease. Ugeskr Laeger 2024; 186:V09230618. [PMID: 38606707 DOI: 10.61409/v09230618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
The incidence of pleural disease is increasing and the mortality and morbidity is high. Many recent RCTs have resulted in evidence-based guidelines published in 2023, pointing towards a more individualized and specialized management. Most patients with pleural disease are admitted at the A and E but can be managed in outpatient clinics. Thus, there is a need to establish specialized, multidisciplinary pleural clinics to ensure optimal, individualized and evidence-based management of the increasing number of patients with pleural disease in Denmark, as argued in this review.
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Affiliation(s)
- Katrine Fjællegaard
- Lungemedicinsk Forskningsenhed (PLUZ), Institut for Regional Sundhedsforskning, Syddansk Universitet
- Lungemedicinsk Afdeling, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | - Jesper Koefod Petersen
- Lungemedicinsk Forskningsenhed (PLUZ), Institut for Regional Sundhedsforskning, Syddansk Universitet
- Lungemedicinsk Afdeling, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | - Casper Jensen
- Lungemedicinsk Forskningsenhed (PLUZ), Institut for Regional Sundhedsforskning, Syddansk Universitet
| | - Daniel Bech Rasmussen
- Lungemedicinsk Forskningsenhed (PLUZ), Institut for Regional Sundhedsforskning, Syddansk Universitet
- Lungemedicinsk Afdeling, Sjællands Universitetshospital, Roskilde og Næstved
| | | | - Christian B Laursen
- Lungemedicinsk Forskningsenhed (ODIN), Klinisk Institut, Syddansk Universitet
- Lungemedicinsk Afdeling, Odense Universitetshospital
| | - Uffe Bødtger
- Lungemedicinsk Forskningsenhed (PLUZ), Institut for Regional Sundhedsforskning, Syddansk Universitet
- Lungemedicinsk Afdeling, Sjællands Universitetshospital, Roskilde og Næstved
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3
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Iglesias Heras M, Juárez Moreno E, Ortiz de Saracho Bobo J, Cascón Hernández J, Fernández García-Hierro JM, Yagüe Zapatero E, Cordovilla Pérez R. Usefulness of thoracic ultrasound in the assessment of removal of indwelling pleural catheter in patients with malignant pleural effusion. RADIOLOGIA 2024; 66 Suppl 1:S24-S31. [PMID: 38642957 DOI: 10.1016/j.rxeng.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/20/2023] [Indexed: 04/22/2024]
Abstract
INTRODUCTION There are no defined criteria for deciding to remove a non-functioning indwelling pleural catheter (IPC) when lung re-expansion on chest X-ray is incomplete. Chest computed tomography (chest CT) is usually used. The objective of this work is to validate the usefulness of chest ultrasound performed by a pulmonologist and by a radiologist compared to chest CT. PATIENTS AND METHODS Prospective, descriptive, multidisciplinary and multicenter study including patients with malignant pleural effusion and non-functioning IPC without lung reexpansion. Decisions made on the basis of chest ultrasound performed by a pulmonologist, and performed by a radiologist, were compared with chest CT as the gold standard. RESULTS 18 patients were analyzed, all of them underwent ultrasound by a pulmonologist and chest CT and in 11 of them also ultrasound by a radiologist. The ultrasound performed by the pulmonologist presents a sensitivity of 60%, specificity of 100%, PPV 100% and NPV 66% in the decision of the correct removal of the IPC. The concordance of both ultrasounds (pulmonologist and radiologist) was 100%, with a kappa index of 1. The 4 discordant cases were those in which the IPC was not located on the ultrasound. CONCLUSIONS Thoracic ultrasound performed by an expert pulmonologist is a valid and simple tool to determine spontaneous pleurodesis and remove a non-functioning IPC, which would make it possible to avoid chest CT in those cases in which lung reexpansion is observed with ultrasonography.
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Affiliation(s)
- M Iglesias Heras
- Servicio de Neumología, Hospital Universitario de Salamanca, Salamanca. Spain.
| | - E Juárez Moreno
- Servicio de Neumología, Hospital El Bierzo, Ponferrada, León, Spain
| | | | - J Cascón Hernández
- Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - E Yagüe Zapatero
- Servicio de Radiodiagnóstico, Hospital El Bierzo, Ponferrada, León, Spain
| | - R Cordovilla Pérez
- Servicio de Neumología, Hospital Universitario de Salamanca, Salamanca. Spain
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Schramm J, Eslauer E, Hammoudeh S, Stange S, Sziklavari Z. Comparison of outcomes of surgical and other invasive treatment modalities for malignant pleural effusion in patients with pleural carcinomatosis. J Thorac Dis 2024; 16:960-972. [PMID: 38505037 PMCID: PMC10944730 DOI: 10.21037/jtd-23-1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/24/2023] [Indexed: 03/21/2024]
Abstract
Background Treatment modalities for malignant pleural effusion (MPE) are diverse. The objectives were to analyze actual clinical data from patients with MPE and pleural carcinomatosis and to compare the outcomes of different treatment modalities with regard to effectiveness, survival, morbidity, and mortality as well as the duration of hospitalization. Methods Patients with pathologically proven pleural carcinomatosis or MPE from 2018 to 2020 were included in this retrospective-observational study with additional questionnaires. We identified four treatment modalities: (I) video-assisted thoracic surgery with pleurodesis (VATS, mechanical/chemical); (II) VATS with pleurodesis combined with indwelling pleural catheter (IPC) placement; (III) VATS (without pleurodesis) combined with IPC placement; and (IV) management with IPC placement alone. Results We enrolled 91 patients aged 38-90 years who were treated by either VATS-pleurodesis (N=22), VATS-IPC placement (N=21), a combination of VATS with pleurodesis and IPC placement (N=22), or IPC placement alone (N=26). The mean survival time was 138.3 days. No significant differences were detected among treatment groups regarding the outcome of pleurodesis failure, either initially or later. Patients in the VATS-pleurodesis with IPC group experienced significantly more complications than those in the other treatment modality groups [odds ratio (OR): 3.288, P=0.026]. However, no statistically significant differences were observed regarding the type of adverse event and survival. Hypoalbuminemia, systemic therapy, and successful pleurodesis (P=0.008; P=0.011; P=0.044, respectively) were significantly correlated with survival. In multiple linear regression, hypoalbuminemia persisted as an independent predictor of survival (P=0.031). The type of intervention showed significant differences regarding the duration of hospitalization (P=0.017). IPC placement alone shortened the mean total hospitalization time by 7.9, 5.9, and 7.0 days compared to VATS-pleurodesis (P≤0.001), VATS-IPC placement (P=0.004), and VATS-pleurodesis with IPC placement (P≤0.001), respectively. Conclusions The survival time was very short, and each treatment group had pros and cons. Therefore, decisions should be made on a case-by-case basis. The use of an IPC, even if the lung is not trapped, can significantly reduce the length of hospital stay. VATS is needed when histology is needed. The ideal method for treating recurrent MPE should be simple, effective, and inexpensive, with minimal disturbance to the patient.
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Affiliation(s)
- Joshua Schramm
- Department of General and Visceral Surgery, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Elina Eslauer
- Department of Anaesthesiology, University Medical Center Augsburg, Augsburg, Germany
| | - Sameer Hammoudeh
- Department of Thoracic Surgery, REGIOMED Klinikum Coburg, Coburg, Germany
| | - Sebastian Stange
- Department of Thoracic Surgery, REGIOMED Klinikum Coburg, Coburg, Germany
| | - Zsolt Sziklavari
- Department of Thoracic Surgery, REGIOMED Klinikum Coburg, Coburg, Germany
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5
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Efteev LA, Esakov YS, Blinova EV, Bazylyuk AV, Blinov KD. [Treatment of malignant effusion]. Khirurgiia (Mosk) 2024:141-147. [PMID: 39008708 DOI: 10.17116/hirurgia2024071141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Malignant effusion complicates more than 15% of all cancers in delayed stages of progression. The most common causes of metastatic pleuritis are lung cancer, breast cancer, ovarian cancer, lymphoproliferative diseases or dissemination of gastrointestinal tumors. Malignant effusion is associated with negative prognosis for overall survival regardless of etiology of tumor, significantly complicates the course of the underlying disease, impairs life quality and complicates treatment. Despite various methods for pleural cavity obliteration in recurrent metastatic pleuritis, there is still no a uniform approach to choosing the optimal treatment strategy. We analyzed the main methods of conservative and surgical treatment of recurrent metastatic pleuritic regarding efficacy, risk of recurrence and reproducibility.
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Affiliation(s)
- L A Efteev
- Clinical Oncological Hospital N. 1, Moscow, Russia
| | - Yu S Esakov
- Clinical Oncological Hospital N. 1, Moscow, Russia
| | - E V Blinova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Bazylyuk
- Clinical Oncological Hospital N. 1, Moscow, Russia
| | - K D Blinov
- Sechenov First Moscow State Medical University, Moscow, Russia
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Zhao Y, Yu L, Wang L, Wu Y, Chen H, Wang Q, Wu Y. Current status of and progress in the treatment of malignant pleural effusion of lung cancer. Front Oncol 2023; 12:961440. [PMID: 36818672 PMCID: PMC9933866 DOI: 10.3389/fonc.2022.961440] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023] Open
Abstract
Malignant pleural effusion (MPE) is a common complication in the late stage of malignant tumors. The appearance of MPE indicates that the primary tumor has spread to the pleura or progressed to an advanced stage. The survival time of the patients will be significantly shortened, with a median survival of only a few months. There are a variety of traditional treatments, and their advantages and disadvantages are relatively clear. There are still many problems that cannot be solved by traditional methods in clinical work. The most common one is intrapleural perfusion therapy with chemotherapy drugs, but it has a large side effect of chemotherapy. At present, with the development of medical technology, there are a variety of treatment methods, and many innovative, significant and valuable treatment methods have emerged, which also bring hope for the treatment of refractory and recurrent MPE patients. Several clinical trials had confirmed that drug-carrying microparticles has less adverse reactions and obvious curative effect. However, there is still a long way to go to completely control and cure MPE, and the organic combination of clinical work and scientific research results is needed to bring dawn to refractory MPE patients.
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Affiliation(s)
| | | | | | | | | | | | - Yufeng Wu
- *Correspondence: Qiming Wang, ; Yufeng Wu,
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7
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Yang L, Wang Y. Malignant pleural effusion diagnosis and therapy. Open Life Sci 2023; 18:20220575. [PMID: 36874629 PMCID: PMC9975958 DOI: 10.1515/biol-2022-0575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/09/2023] [Accepted: 01/22/2023] [Indexed: 03/06/2023] Open
Abstract
Malignant pleural effusion (MPE) is a serious complication of advanced tumor, with relatively high morbidity and mortality rates, and can severely affect the quality of life and survival of patients. The mechanisms of MPE development are not well defined, but much research has been conducted to gain a deeper understanding of this process. In recent decades, although great progress has been made in the management of MPE, the diagnosis and treatment of MPE are still major challenges for clinicians. In this article, we provide a review of the research advances in the mechanisms of MPE development, diagnosis and treatment approaches. We aim to offer clinicians an overview of the latest evidence on the management of MPE, which should be individualized to provide comprehensive interventions for patients in accordance with their wishes, health status, prognosis and other factors.
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Affiliation(s)
- Liangliang Yang
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Erdao District, Changchun 130033, China
| | - Yue Wang
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Erdao District, Changchun 130033, China
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8
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Sezenöz B, Pınar Uyar Göçün F, Kızıltunç E, Topal S, Murat Özdemir H. The Prognostic Impact of Pericardial Fluid Cytology in Malignant Pericardial Effusion. Anatol J Cardiol 2023; 27:41-46. [PMID: 36680446 PMCID: PMC9893710 DOI: 10.14744/anatoljcardiol.2022.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/02/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Malignant pericardial effusion may affect almost 15 of the patients with underlying malignancies which deteriorates the prognosis. The prognostic significance of pericardial fluid cytology is under-represented in previous studies. METHODS A total of 73 patients with symptomatic pericardial effusion treated with pericardiocentesis were included in this retrospective analysis. Macroscopic appearance, biochemical features, and cytological findings were obtained. Patients were divided into 3 groups: (i) without malignancy, (ii) with malignancy and negative cytology, and (iii) with malignancy and positive cytology. Survival data were searched via governmental death notification system. RESULTS Mean age of the study group was 62 ± 15, and 54% (40) of the patients were female. On the cytological evaluation, 17 patients (23.3%) revealed positive cancer cytology, whereas 56 patients (76.7%) revealed negative cancer cytology. The median follow-up period was 840 days, and 34 patients (46.5%) died during follow-up. The survival rate of Group 3 was found to be significantly worse compared to Groups 1 and 2, no statistical difference was found between Groups 1 and 2 in terms of survival (Group 1 vs. Group 2 P =.078; Group 1 vs. Group 3 P <.001; Group 2 vs. Group 3 P =.041). CONCLUSION Cytological evaluation is an important step in patients with malignant pericardial effusion. Positive pericardial fluid cytology indicates a poorer prognosis.
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Affiliation(s)
- Burak Sezenöz
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | | - Emrullah Kızıltunç
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Salih Topal
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Taniguchi Y, Matsuda Y, Mori M, Ito M, Ikari T, Tokoro A, Aiki S, Hoshino S, Kiuchi D, Suzuki K, Igarashi Y, Odagiri T, Oya K, Kubo E, Yamaguchi T. Effectiveness and safety of opioids for dyspnea in patients with lung cancer: secondary analysis of multicenter prospective observational study. Transl Lung Cancer Res 2022; 11:2395-2402. [PMID: 36636410 PMCID: PMC9830271 DOI: 10.21037/tlcr-22-512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022]
Abstract
Background Patients with lung cancer are more likely to have comorbidities [e.g., interstitial lung disease (ILD)], chronic obstructive pulmonary disease) and metastases that may affect dyspnea and the effectiveness and safety of opioids for dyspnea than other cancer types. Therefore, this study examined the effectiveness and safety of opioids for dyspnea, among the patients with lung cancer. Methods The present study is a secondary analysis of a multicenter prospective observational study examining the effectiveness and safety of opioids for dyspnea in patients with cancer in Japan. For this secondary analysis, patients with lung cancer with a documented dyspnea Numerical Rating Scale (NRS) at baseline were included. The primary outcome was dyspnea NRS, and Integrated Palliative care Outcome Scale/Support Team Assessment Schedule (IPOS/STAS) scores change between baseline and 24 hours after baseline. As secondary outcomes, we investigated the predictors of opioid effectiveness for dyspnea improvement and adverse events (nausea, somnolence, and delirium). Results This study analyzed 124 patients with lung cancer with known dyspnea NRS at baseline. The median age was 74, and the Eastern Cooperative Oncology Group performance status of 107 patients were 3-4. Both NRS and IPOS/STAS score of dyspnea significantly improved 24 hours after opioid initiation [-1.64, 95% confidence interval (CI): -2.12 to -1.17, P<0.001; -1.03; 95% CI: -1.21 to -0.85, P<0.001; respectively]. Moreover, the improvement of NRS score was greater than the minimal clinically important difference of 1 point. In the multivariate logistic regression analysis, ILD was significantly associated with a better improvement [(hazard ratio (HR): 3.39, 95% CI: 1.34-11.09, P=0.043]. Somnolence was the most common grade 3-4 adverse event (n=16), followed by delirium (n=9). Conclusions Opioids were effective and safe for treating dyspnea in patients with lung cancer. Furthermore, lung cancer patients with ILD may benefit more from opioids.
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Affiliation(s)
- Yoshihiko Taniguchi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Madoka Ito
- Department of Palliative Care, Konan Medical Center, Kobe, Japan
| | - Tomoo Ikari
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Akihiro Tokoro
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Sayo Aiki
- Department of Palliative Care, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shunya Hoshino
- Department of Palliative Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Daisuke Kiuchi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan;,Department of Palliative Care, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Yuko Igarashi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | | | - Emi Kubo
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Zieliński K, Gólczewski T, Kozarski M, Darowski M. Virtual and Artificial Cardiorespiratory Patients in Medicine and Biomedical Engineering. MEMBRANES 2022; 12:membranes12060548. [PMID: 35736257 PMCID: PMC9227245 DOI: 10.3390/membranes12060548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 12/10/2022]
Abstract
Recently, ‘medicine in silico’ has been strongly encouraged due to ethical and legal limitations related to animal experiments and investigations conducted on patients. Computer models, particularly the very complex ones (virtual patients—VP), can be used in medical education and biomedical research as well as in clinical applications. Simpler patient-specific models may aid medical procedures. However, computer models are unfit for medical devices testing. Hybrid (i.e., numerical–physical) models do not have this disadvantage. In this review, the chosen approach to the cardiovascular system and/or respiratory system modeling was discussed with particular emphasis given to the hybrid cardiopulmonary simulator (the artificial patient), that was elaborated by the authors. The VP is useful in the education of forced spirometry, investigations of cardiopulmonary interactions (including gas exchange) and its influence on pulmonary resistance during artificial ventilation, and explanation of phenomena observed during thoracentesis. The artificial patient is useful, inter alia, in staff training and education, investigations of cardiorespiratory support and the testing of several medical devices, such as ventricular assist devices and a membrane-based artificial heart.
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Røpke A, Morville AL, Møller TE, Delkus ECG, Juhl CB. HIP Fracture REhabilitation Program for older adults with hip fracture (HIP-REP) based on activity of daily living: a feasibility study. BMC Geriatr 2022; 22:370. [PMID: 35477380 PMCID: PMC9044869 DOI: 10.1186/s12877-022-03039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background A Rehabilitation Program for older adults with hip fracture (HIP-REP) based on Activity of Daily Living has been developed. The objectives of this study were to assess the feasibility and safety of the HIP-REP program to inform a future randomized controlled trial (RCT). Methods A feasibility study Inspired by the Complex-intervention development (Medical Research Council framework phase II) design using quantitative and qualitative research methods were conducted. Eighteen participants (above 65 years) with hip fracture were recruited from the orthopedic wards. The setting was cross sectoral including Copenhagen University Hospital, Herlev and Gentofte and rehabilitation centers in Herlev, Gentofte and Lyngby-Taarbæk municipalities. A cross-sectoral rehabilitation intervention tailored to the needs of older adults with hip fracture highlighting systematic goal setting and strategies focused on activities of daily living was conducted. Pre-defined feasibility criteria: participants recruitment and retention, duration of measuring the outcome, adherence to intervention, and adverse events, along with self-reported outcomes and an objective measurement of performance in activity of daily living. Focus groups were analyzed using a deductive manifest content analysis approach. Descriptive statistical analysis and paired t-tests were performed for assessing change in outcome measures. Results Recruitment rate was 4.5/month. Outcome measures were performed but length and number of questionnaires were a burden. Thirteen out of eighteen participants completed the study three dropped out and two died. Adherence among the 13 was 100%. Focus group revealed issues regarding coordinating the intervention, ensuring procedural processes across sectors regarding recruitment of participants, and documentation in the database. Participants expressed satisfaction with the intervention and felt safe during intervention. Assessment of Motor and Process Skills showed better increase between (range 0.4 to 1.6) in ADL motor ability measures and better increase between (range 0.4 to 0.7) for process ability. No clear association between outcome improvements and intervention adherence. Conclusions The cross-sectoral intervention based on daily activities was feasible and safe for older adults with hip fracture. A future RCT, with an improved recruitment strategy and reduced number of outcome measures will evaluate the effectiveness in improving independence and safety performance of activity of daily living. Trial registration ClinicalTrials.gov ID: NCT03828240. Registered on January 29, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03039-x.
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Affiliation(s)
- Alice Røpke
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark. .,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Anne-Le Morville
- ADULT Research Group, Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Trine Elleby Møller
- Municipality of Gentofte, Municipality of Gentofte's Centre for Prevention and Rehabilitation, Copenhagen, Denmark
| | | | - Carsten Bogh Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Kumar N, Goel N. Recent development of imidazole derivatives as potential anticancer agents. PHYSICAL SCIENCES REVIEWS 2022. [DOI: 10.1515/psr-2021-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Cancer, one of the key health problems globally, is a group of related diseases that share a number of characteristics primarily the uncontrolled growth and invasive to surrounding tissues. Chemotherapy is one of the ways for the treatment of cancer which uses one or more anticancer agents as per chemotherapy regimen. Limitations of most anticancer drugs due to a variety of reasons such as serious side effects, drug resistance, lack of sensitivity and efficacy etc. generate the necessity towards the designing of novel anticancer lead molecules. In this regard, the synthesis of biologically active heterocyclic molecules is an appealing research area. Among heterocyclic compounds, nitrogen containing heterocyclic molecules has fascinated tremendous consideration due to broad range of pharmaceutical activity. Imidazoles, extensively present in natural products as well as synthetic molecules, have two nitrogen atoms, and are five membered heterocyclic rings. Because of their countless physiological and pharmacological characteristics, medicinal chemists are enthused to design and synthesize new imidazole derivatives with improved pharmacodynamic and pharmacokinetic properties. The aim of this present chapter is to discuss the synthesis, chemistry, pharmacological activity, and scope of imidazole-based molecules in anticancer drug development. Finally, we have discussed the current challenges and future perspectives of imidazole-based derivatives in anticancer drug development.
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Affiliation(s)
- Naresh Kumar
- Department of Biosciences and Biomedical Engineering , Indian Institute of Technology Indore , Indore , Madhya Pradesh 453552 , India
| | - Nidhi Goel
- Department of Chemistry , Institute of Science, Banaras Hindu University , Varanasi , Uttar Pradesh 221005 , India
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13
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Mohs Z, DeVillers M, Ziegler S, Basson MD, Newman W. Management of Malignant Pleural Effusions in U.S. Veterans: A Retrospective Review. Ann Thorac Cardiovasc Surg 2022; 28:420-428. [PMID: 36328570 PMCID: PMC9763720 DOI: 10.5761/atcs.oa.22-00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To compare malignant pleural effusion (MPE) treatment outcomes and complications among patients receiving indwelling pleural catheter (IPC), talc pleurodesis (TPS), or dual therapy. Outcomes were determined by measuring length of stay (LOS) and post-procedure dyspnea scores. Complications were measured by comparing intervention failures and adverse events. METHODS The Veterans Affairs' Corporate Data Warehouse was utilized to retrospectively review the charts of 314 MPE subjects. Dyspnea scores were estimated by researchers and LOS was determined by adding the duration of stay for all admissions post procedure. Complications were recorded through chart review. RESULTS IPC exhibited higher failure rates than the other approaches 1 year post intervention. Pneumonia/chest infection rate and lung entrapment were also more prevalent. There was no significant difference in dyspnea rates. LOS illustrated a significant difference between groups, with talc patients spending a median of 7 days in the hospital immediately post procedure, while IPC and IPC + TPS patients spent a median of 3 and 2 days, respectively. CONCLUSION Patients receiving IPC or combination treatment spend fewer days in the hospital than TPS patients. However, IPC appears to be associated with more adverse events and higher long-term failure rates than other management strategies.
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Affiliation(s)
- Zachary Mohs
- Department of Internal Medicine, UND School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Megan DeVillers
- Department of Internal Medicine, UND School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Stephanie Ziegler
- Department of Internal Medicine, UND School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Marc D. Basson
- Department of Surgery, UND School of Medicine and Health Sciences, Grand Forks, ND, USA,Corresponding author: Marc D. Basson. Department of Surgery, UND School of Medicine and Health Sciences, 1301 N Columbia Rd, Grand Forks, ND 58203, USA
| | - William Newman
- Department of Internal Medicine, UND School of Medicine and Health Sciences, Grand Forks, ND, USA,Department of Internal Medicine, Fargo Veterans Affairs Medical Center, Fargo, ND, USA
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14
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Addala DN, Kanellakis NI, Bedawi EO, Dong T, Rahman NM. Malignant pleural effusion: Updates in diagnosis, management and current challenges. Front Oncol 2022; 12:1053574. [PMID: 36465336 PMCID: PMC9712949 DOI: 10.3389/fonc.2022.1053574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
Malignant pleural effusion (MPE) is a common condition which often causes significant symptoms to patients and costs to healthcare systems. Over the past decade, the management of MPE has progressed enormously with large scale, randomised trials answering key questions regarding optimal diagnostic strategies and effective management strategies. Despite a number of management options, including talc pleurodesis, indwelling pleural catheters and combinations of the two, treatment for MPE remains symptom directed and centered around drainage strategy. The future goals for providing improved care for patients lies in changing the treatment paradigm from a generic pathway to personalised care, based on probability of malignancy type and survival. This article reviews the current evidence base, new discoveries and future directions in the diagnosis and management of MPE.
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Affiliation(s)
- Dinesh Narayan Addala
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Oxford Pleural Unit, Oxford University Hospitals, Oxford, United Kingdom
| | - Nikolaos I Kanellakis
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Oxford Biomedical Research Centre, National Institute for Health Research, Oxford, United Kingdom.,Nuffield Department of Medicine, Medical Sciences Division, Chinese Academy of Medical Science Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Eihab O Bedawi
- Oxford Pleural Unit, Oxford University Hospitals, Oxford, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Tao Dong
- Nuffield Department of Medicine, Medical Sciences Division, Chinese Academy of Medical Science Oxford Institute, University of Oxford, Oxford, United Kingdom.,Medical Research Council (MRC) Human Immunology Unit, Radcliffe Department of Medicine, Medical Research Council (MRC) Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Oxford Pleural Unit, Oxford University Hospitals, Oxford, United Kingdom.,Oxford Biomedical Research Centre, National Institute for Health Research, Oxford, United Kingdom.,Nuffield Department of Medicine, Medical Sciences Division, Chinese Academy of Medical Science Oxford Institute, University of Oxford, Oxford, United Kingdom
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15
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Mai Z, Feng B, He Q, Feng Q. Medical Thoracoscopic Thermal Ablation Therapy for Metastatic Pleural Tumors with Malignant Effusion: An Exploratory Retrospective Study. Int J Gen Med 2021; 14:9349-9360. [PMID: 34898999 PMCID: PMC8654692 DOI: 10.2147/ijgm.s339596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Malignant pleural effusion (MPE) is an intractable condition. The current mainstream therapies for MPE, ie, indwelling pleural catheter and pleurodesis, have some drawbacks. In this retrospective study, we explored the efficacy and safety of medical thoracoscopic thermal ablation (argon plasma coagulation, APC) therapy for metastatic pleural tumors with MPE. Patients and Methods A total of 176 patients were enrolled and divided into catheter pleural drainage (CPD) group (n = 77), non-ablation group (n = 46), and thermal ablation group (n = 53). Propensity score matching (PSM) was used for between-group comparisons to minimize bias. The primary endpoints were pleural effusion objective response rate (ORR) and time to progression (TTP); secondary endpoints included overall survival (OS), chest-tube duration, and safety. Results Thermal ablation group and non-ablation group showed significantly higher ORR and shorter chest-tube duration versus the CPD group (ORR: thermal ablation, 88.2% vs 66.7%, P = 0.004; non-ablation, 88.4% vs 64.4%, P = 0.042; chest-tube duration: thermal ablation, 4.90 vs 7.24 days, P < 0.001; non-ablation, 5.73 vs 7.33 days, P = 0.010). Thermal ablation group exhibited longer TTP than the CPD group (median, 13.7 vs 7.3 months, P = 0.001) and the non-ablation group (median, 13.6 vs 10.3 months, P = 0.037). OS in the thermal ablation group was numerically longer than that in the CPD group with marginally significant difference (P = 0.055). There was no significant difference in the frequency of adverse events or changes in vital signs between thermal ablation and non-ablation groups. Conclusion Medical thoracoscopic thermal ablation (APC technique) therapy was effective and safe in the treatment of metastatic pleural tumors with MPE for improving ORR and TTP.
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Affiliation(s)
- Zhonglun Mai
- Department of Thoracic Oncology, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, 510315, People's Republic of China
| | - Bin Feng
- Department of Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, 510630, People's Republic of China
| | - Qianwen He
- Department of Geriatrics, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, 510315, People's Republic of China
| | - Qixiao Feng
- Department of Thoracic Oncology, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, 510315, People's Republic of China
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16
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Zvěřina O, Venclíček O, Kuta J, Coufalík P, Hagarová I, Brat K. A simple dilute-and-shoot procedure for the determination of platinum in human pleural effusions using HR-CS GF-AAS. J Trace Elem Med Biol 2021; 68:126869. [PMID: 34601283 DOI: 10.1016/j.jtemb.2021.126869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND High-resolution continuum source AAS is an emerging technique for the determination of trace elements in clinical analysis. We aimed to develop a method for the direct determination of platinum (Pt) in pleural effusions that could deepen the understanding of the dynamics of intrapleural Pt concentration during cytostatic therapy. MATERIALS AND METHODS Samples were collected by thoracic drainage from five patients with lung cancer undergoing platinum based chemotherapy. A simple dilute-and-shoot method for Pt determination in the pleural effusions was developed. Ashing of the sample in an oxygen flow in a graphite tube allowed for direct analysis without prior mineralization. The trueness of the method was verified using an independent technique (ICP-MS). As platinum derivatives are only active in its free form (not bound to proteins), Pt in samples was further divided into free and protein-bound forms by means of ultrafiltration. RESULTS Using the proposed method, Pt contents (free and total) were determined in samples collected at different times after the intravenous application of the Pt derivative. The concentration of total Pt reached values of up to 5,000 μg/L and different patterns of its dynamics in intrapleural fluid were observed. CONCLUSIONS The developed method enables the fast and simple determination of Pt in biological fluids. It may be applied on a large scale to improve the understanding of Pt dynamics during cytostatic therapy, and also to determine the optimal timing of both thoracic drainage and administration of systemic chemotherapy.
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Affiliation(s)
- Ondřej Zvěřina
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.
| | - Ondřej Venclíček
- Department of Respiratory Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Jan Kuta
- Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Pavel Coufalík
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, 602 00, Brno, Czech Republic
| | - Ingrid Hagarová
- Institute of Laboratory Research on Geomaterials, Faculty of Natural Sciences, Comenius University in Bratislava, Slovakia
| | - Kristián Brat
- Department of Respiratory Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
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17
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Misra SK, Pathak K. Naturally occurring heterocyclic anticancer compounds. PHYSICAL SCIENCES REVIEWS 2021. [DOI: 10.1515/psr-2021-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Naturally occurring heterocyclic scaffolds are key ingredients for the development of various therapeutics employed for biomedical applications. Heterocyclic pharmacophores are widely disseminated and have been befallen in almost all categories of drugs for the alleviation of myriad ailments including diabetes, neurodegenerative, psychiatric, microbial infections, disastrous cancers etc. Countless fused heterocyclic anticancerous templates are reported to display antimetabolite, antioxidant, antiproliferative, cytostatic etc. pharmacological actions via targeting different signaling pathways (cell cycle, PI-3kinase/Akt, p53, caspase extrinsic pathway etc.), overexpressive receptors (EGRF, HER2, EGF, VEGF etc.) and physiological enzymes (topoisomerase I and II, cyclin dependent kinase etc.). A compiled description on various natural sources (plants, microbes, marine) containing anticancer agents comprising heterocyclic ring specified with presence of nitrogen (vincristine, vinblastine, indole-3-carbinol, meridianins, piperine, lamellarins etc.), oxygen (paclitaxel, halichondrin B, quercetin, myricetin, kaempferol etc.) and sulphur atoms (brugine, fucoidan, carrageenan etc.) are displayed here along with their molecular level cytotoxic action and therapeutic applications.
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Affiliation(s)
- Shashi Kiran Misra
- University Institute of Pharmacy, Chhatrapati Shahu Ji Maharaj University , Kanpur , 208026 , India
| | - Kamla Pathak
- Faculty of Pharmacy, Uttar Pradesh University of Medical Sciences , Saifai , Etawah , 206130 , Uttar Pradesh , India
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18
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Sun Y, Hu Y, Wan C, Lovell JF, Jin H, Yang K. Local biomaterial-assisted antitumour immunotherapy for effusions in the pleural and peritoneal cavities caused by malignancies. Biomater Sci 2021; 9:6381-6390. [PMID: 34582527 DOI: 10.1039/d1bm00971k] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Malignant pleural effusion (MPE) and malignant ascites (MA), which are common but serious conditions caused by malignancies, are related to poor quality of life and high mortality. Current treatments, including therapeutic thoracentesis and indwelling pleural catheters or paracentesis and catheter drainage, are largely palliative. An effective treatment is urgently needed. MPE and MA are excellent candidates for intratumoural injections that have direct contact with tumour cells and kill tumour cells more effectively and efficiently with fewer side effects, and the fluid environment of MPE and MA can provide a homogeneous area for drug distribution. The immunosuppressive environments within the pleural and peritoneal cavities suggest the feasibility of local immunotherapy. In this review, we introduce the current management of MPE and MA, discuss the latest advances and challenges in utilizing local biomaterial-assisted antitumour therapies for the treatment of MPE and MA, and discuss further opportunities in this field.
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Affiliation(s)
- Yajie Sun
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Yan Hu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Chao Wan
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Jonathan F Lovell
- Department of Chemical and Biological Engineering, University at Buffalo, State University of New York. Buffalo, New York, 14260, USA
| | - Honglin Jin
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Kunyu Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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19
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Williams JG, Lerner AD. Managing complications of pleural procedures. J Thorac Dis 2021; 13:5242-5250. [PMID: 34527363 PMCID: PMC8411187 DOI: 10.21037/jtd-2019-ipicu-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/29/2020] [Indexed: 11/06/2022]
Abstract
Pleural disease is common and often requires procedural intervention. Given this prevalence, pleural procedures are performed by a wide range of providers with varying skill level in both medical and surgical specialties. Even though the overall complication rate of pleural procedures is low, the proximity to vital organs and blood vessels can lead to serious complications which if left unrecognized can be life threatening. As a result, it is of the utmost importance for the provider to have a firm grasp of the local anatomy both conceptually when preparing for the procedure and physically, via physical exam and the use of a real time imaging modality such as ultrasound, when performing the procedure. With this in mind, anyone who wishes to safely perform pleural procedures should be able to appropriately anticipate, quickly identify, and efficiently manage any potential complication including not only those seen with many procedures such as pain, bleeding, and infection but also those specific to procedures performed in the thorax such as pneumothorax, re-expansional pulmonary edema, and regional organ injury. In this article, we will review the basic approach to most pleural procedures along with essential local anatomy most often encountered during these procedures. This will lay the foundation for the remainder of the article where we will discuss clinical manifestations and management of various pleural procedure complications.
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Affiliation(s)
- John G Williams
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew D Lerner
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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20
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A multidirectional two-tube method for chemical pleurodesis could improve distribution of the sclerosing agent within the pleural cavity - A pilot study. Ann Med Surg (Lond) 2021; 68:102697. [PMID: 34408869 PMCID: PMC8361043 DOI: 10.1016/j.amsu.2021.102697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction Malignant pleural effusion (MPE) affects approximately 200,000 people in the United States per annum. Chemical pleurodesis is a recommended first line treatment in the management of MPE, however, success rates as low as 43% has been reported. A bedside chemical pleurodesis can cost up to $11,224 and an estimated inpatient annual expenditure of more than $5 billion in the US alone. This study aims to assess the distribution of the talc slurry within the pleural space using human cadaveric models and to determine the force required to push the talc slurry though a 14 Fr chest tube. Materials and methods The force required to administer the talc slurry through a 14 Fr chest tube was tested using a Zwick/Roelle Z005 mechanical tester, using a porcine thoracic biomodel. Talc slurry distribution within the pleural cavity was assessed by direct visualisation following administration to the human cadaveric models using single and multidirectional two-tube methods. Results Maximum force required to push the talc slurry through a 14 Fr chest tube was 11.36 N ± 2.79 N. Distribution of the talc slurry within the pleural cavity was found to be poor with a single tube method. Multidirectional two-tube method of administration showed more even distribution. Conclusion The experimental multidirectional two-tube method results in wider distribution of the talc slurry within the pleural cavity and could further improve success rate of the talc pleurodesis. Yearly, there are over 150,000 new cases of MPE in the US alone. Success rate of talc pleurodesis as low as 43% has been reported. Doctor's hand grip strength does not affect the talc distribution within the pleural cavity. Bedside multidirectional two-tube method may improve the success rate of talc slurry pleurodesis.
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21
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Frost N, Ruwwe-Glösenkamp C, Raspe M, Brünger M, Temmesfeld-Wollbrück B, Suttorp N, Witzenrath M. Indwelling pleural catheters for non-malignant pleural effusions: report on a single centre's 10 years of experience. BMJ Open Respir Res 2021; 7:7/1/e000501. [PMID: 31958272 PMCID: PMC7011895 DOI: 10.1136/bmjresp-2019-000501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/18/2019] [Accepted: 01/03/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Recurrent pleural effusion is a common cause of dyspnoea, cough and chest pain during the course of infectious pleurisy and non-malignant diseases like congestive heart failure (CHF) or liver cirrhosis with hepatic hydrothorax (HH). With regard to the chronic character of the underlying diseases, indwelling pleural catheters (IPC) are increasingly used, not only assuring immediate symptom relief but also potentially leading to pleurodesis without sclerosing agents. PATIENTS AND METHODS In this single-centre retrospective observational study, patient characteristics, procedural variables and outcome in patients with IPC in non-malignant pleural effusion (NMPE) were evaluated and prognostic factors for pleurodesis were identified. RESULTS From 2006 to 2017, 54 patients received 62 IPC, of whom 48.4% with CHF and 43.5% with HH. The median length of insertion was 1.5 months (IQR 0.6-2.9 months), the median survival time after insertion 3.2 months (IQR 1.1-16.0). An adequate symptom relief was achieved in 93.2% with no need for subsequent interventions. In patients surviving ≥30 days after IPC insertion, pleurodesis was observed in 45.9%, being associated to age (<55 years, p=0.02), the primary diagnosis (p=0.03) and interventions for the underlying disease (p<0.001). Complications occurred in 24.2% of all procedures (n=15), the majority concerning mechanical obstructions (n=10) and infections (n=4). Patients with HH had an excess risk for complications (37.3%). CONCLUSION Efficacy in symptom relief and a generally manageable safety profile recommend IPC as a first-line treatment option in NMPE, where disease-specific treatments are exhausted. Caution is warranted in patients with HH due to an excess risk for complications.
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Affiliation(s)
- Nikolaj Frost
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph Ruwwe-Glösenkamp
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthias Raspe
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Brünger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bettina Temmesfeld-Wollbrück
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Division of Pulmonary Inflammation, Charíté-Universitätsmedizin Berlin, Berlin, Germany
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22
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Diggs LP, Martin SP, Drake JA, Ripley RT. Video-assisted thoracoscopic surgery pleurectomy: a suitable alternative for treating malignant pleural effusions. J Thorac Dis 2021; 13:2177-2183. [PMID: 34012568 PMCID: PMC8107536 DOI: 10.21037/jtd-19-3261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Malignant pleural effusions (MPEs) are common manifestations of metastatic cancers and are associated with a dismal prognosis. Talc pleurodesis has been proven to be effective in the management of MPEs, however, class-action lawsuits linking talc to ovarian adenocarcinoma have rendered it unavailable at many institutions. As a result, surgeons have resorted to less effective chemical pleurodesis as an alternative to indwelling pleural drainage catheters. Given the absence of talc, we explored the effectiveness of video-assisted thoracoscopic surgery (VATS) partial pleurectomy (VPP) for treating MPEs. Methods We performed a retrospective review of patients with MPEs managed after talc became unavailable at our institution. Between 2016 and 2018, we identified five patients who refused pleural drainage catheters and underwent VPP. Symptoms at presentation included fatigue, dyspnea, and pleuritic chest pain. All had unilateral MPEs (left n=3, right n=2). VPP included removal of parietal surfaces of the pleura other than the pleura overlying the subclavian vessels, the mediastinum, and the lung viscera. Results There were no significant perioperative adverse events and post-operative pain was well controlled. Chest tubes were removed between post-operative day (POD) 3 and 7. Follow-up time ranged from four to 36 weeks. All patients had symptomatic relief and radiographic evidence of improved MPEs. No patients required re-interventions. One patient expired six months after surgery while the remaining four were alive at last follow-up. Conclusions VPP offers an effective alternative to chemical pleurodesis for managing MPEs in patients who prefer to avoid pleural drainage catheters.
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Affiliation(s)
- Laurence P Diggs
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sean P Martin
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Justin A Drake
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - R Taylor Ripley
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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23
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Hutchinson AH, Fakhouri EW, Raudales J. Recurrent Large Volume Malignant Pleural Effusion in a Patient With Renal Cell Carcinoma. Cureus 2021; 13:e13593. [PMID: 33815993 PMCID: PMC8009455 DOI: 10.7759/cureus.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Malignant pleural effusion (MPE) due to renal cell carcinoma (RCC) is extremely rare, accounting for only 1%-2% of all malignant pleural effusions. This paper presents a case report of a 56-year-old male who presented with a chief complaint of bilateral flank pain with dyspnea and was diagnosed with RCC via immunopathologic pleural fluid analysis and who persistently had recurrent large volume pleural effusion. A 56-year-old male who had a recent admission for dyspnea secondary to a right-sided pleural effusion underwent thoracentesis and returned to the hospital for his worsening shortness of breath. He was found to have recurrent pleural effusion. Thoracentesis studies revealed an exudative pleural effusion positive for malignant cells showing adenocarcinoma, which had an immunopathologic profile (WT-1 and PAX8) favoring an adenocarcinoma of kidney origin. The patient underwent chest tube placement, followed by chemical pleurodesis with 4.3 L of bloody fluid drained immediately. Subsequent x-rays taken while the chest tube was in place showed worsening reaccumulating pleural effusion. A repeat CT scan showed a large right pleural effusion with loculated collections. The patient then underwent right video-assisted thoracoscopic surgery, which revealed a loculated effusion with pleural carcinomatosis that was biopsy-positive for RCC. This report presents a rare case displaying how RCC pleural carcinomatosis can cause a patient to present with dyspnea secondary to a pleural effusion, which was revealed to be RCC upon fluid cytology and immunohistopathology studies. This case demonstrates that RCC can cause recurrent large volume MPE, which has not been widely reported in contemporary literature.
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Affiliation(s)
- Akil H Hutchinson
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Eddie W Fakhouri
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Juan Raudales
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
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24
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Li JX, Shi YM, An LY, Yang JX, Qi YX, Yang T, Cen YY, Lin YY, Sun DL. Quality assessment of the guidelines for the management of malignant pleural effusions and ascites. World J Surg Oncol 2020; 18:331. [PMID: 33308239 PMCID: PMC7733286 DOI: 10.1186/s12957-020-02097-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/27/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives To fully assess the quality of the guidelines for the management of malignant pleural effusions (MPE) and ascites and reveal the heterogeneity of recommendations and possible reasons among guidelines. Methods A systematic search was performed in the database to obtain guidelines for the management of MPE and ascites. The AGREE IIGtool was used to assess the quality of these guidelines. The Measurement Scale of Rate of Agreement (MSRA) was introduced to assess the scientific agreement of formulated recommendations for the management of MPE and ascites among guidelines, and evidence supporting these recommendations was extracted and analyzed. Results Nine guidelines were identified. Only 4 guidelines scored more than 60% and are worth recommending. Recommendations were also heterogeneous among guidelines for the management of MPE, and the main reasons were the different emphases of the recommendations for the treatment of MPE, the contradictions in recommendations, and the unreasonably cited evidence for MPE. Conclusions The quality of the management guidelines for patients with MPE and malignant ascites was highly variable. Specific improvement of the factors leading to the heterogeneity of recommendations will be a reasonable and effective way for developers to upgrade the recommendations in the guidelines for MPE.
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Affiliation(s)
- Jia-Xi Li
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Yan-Mei Shi
- Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Li-Ya An
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Jin-Xu Yang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Yu-Xing Qi
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Ting Yang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Yun-Yun Cen
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China.
| | - Yue-Ying Lin
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China.
| | - Da-Li Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China.
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Garzón JC, Edward Vinck E, Carolina Cárdenas D, Jaime Téllez L. Video-assisted thoracoscopic iodopovidone pleurodesis for malignant pleural effusions in moderate to high-risk Colombian patients. J Cardiovasc Thorac Res 2020; 12:328-333. [PMID: 33510883 PMCID: PMC7828754 DOI: 10.34172/jcvtr.2020.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/15/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: In developing countries where talc may not be readily available, video-assisted thoracoscopic (VATS) iodopovidone pleurodesis offers an excellent alternative for the treatment of malignant pleural effusions (MPEs).
Methods: This study analyzes a retrospective experience using VATS iodopovidone pleurodesis for malignant pleural effusions at a single cardiothoracic center in the capital of Colombia evaluating success according to LENT (Lactate, Eastern Cooperative Oncology Group-ECOG, Neutrophil-Lymphocyte ratio, Tumor type) scores. A total of 75 records of patients taken to VATS iodopovidone pleurodesis for MPEs were retrieved from our institutional database during a 5-year period from 2014-2019. Of these, 45 had complete clinical history data necessary to analyze both LENT scores and post-op follow-up imaging.
Results: Of the 45 patients evaluated, 93.3% (42 patients) had either complete resolution of pleural effusions or partial resolution with an asymptomatic recovery within the first month post op. Chest pain was the most common postoperative complaint, which was present in 20% of patients. The mean postoperative ECOG score was 2±1.7. Patients with moderate to high-risk LENT scores had success rates of 96.7% and 92.3% respectively.
Conclusion: Video-assisted thoracoscopic pleurodesis using Iodopovidone-iodine is an effective approach for MPEs. In developing countries where Iodopovidone iodine is readily available and affordable, patients may benefit from this agent with excellent results and minimal complications.
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Affiliation(s)
- Juan Carlos Garzón
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
| | - Eric Edward Vinck
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
| | - Diana Carolina Cárdenas
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
| | - Luis Jaime Téllez
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
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Chang Y, Cho D, Cho K, Cho M. Viscum pleurodesis is as effective as talc pleurodesis and tends to have less adverse effect. Support Care Cancer 2020; 28:5463-5467. [PMID: 32166382 PMCID: PMC7546984 DOI: 10.1007/s00520-020-05405-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 03/06/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Many patients diagnosed with advanced cancer have malignant pleural effusion that does not respond to chemotherapy or radiation therapy. These patients often have respiratory symptoms, especially dyspnea. In order to relieve these symptoms, various procedures including chemical pleurodesis have been performed. Although talc is the most widely used and effective sclerosing agent, there it has various adverse effects. The objective of this study was to determine whether Viscum (ABNOVA Viscum® Fraxini Injection, manufactured by ABNOVA GmbH, Germany) could be used as an agent to replace talc in clinical practice. METHODS Data of 56 patients with malignant pleural effusion who received chemical pleurodesis after tube thoracostomy from January 2003 to December 2017 were retrospectively reviewed to analyze clinical course and response after pleurodesis with each agent. RESULTS After pleurodesis, changes in numeric rating scale (NRS) was 1.4 ± 1.6 in the talc group and 0.5 ± 1.5 in the Viscum group (p = 0.108). Changes in white blood cell counts after pleurodesis were 4154.8 ± 6710.7 in the talc group and 3487.3 ± 6067.7 in the Viscum group (p = 0.702). Changes in C-reactive protein (CRP) were 9.03 ± 6.86 in the talc group and 6.3 ± 7.5 in the Viscum group (p = 0.366). The success rate of pleurodesis was 93.3% in the talc group and 96% in the Viscum group (p = 0.225). CONCLUSION Viscum pleurodesis showed comparable treatment results with talc pleurodesis while its adverse effects such as chest pain and fever tended to be relatively weak.
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Affiliation(s)
- YongJin Chang
- Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - DeogGon Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - KyuDo Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - MinSeop Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Mytinger A, Taylor T, Gershman E, Shojaee S. Pleural Disease Management: Manometry-guided Thoracentesis, Optimal Drainage Regimen of Indwelling Pleural Catheters, and Talc Poudrage versus Slurry for Malignant Pleural Effusion. Am J Respir Crit Care Med 2020; 202:448-450. [PMID: 32421351 DOI: 10.1164/rccm.202003-0599rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrea Mytinger
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Trevor Taylor
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Evgeni Gershman
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Samira Shojaee
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
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Jeffries J, Gayed M, Ha TGV, Navuluri R. Management of Malignant Pleural Effusions and Malignancy-Related Ascites. Semin Intervent Radiol 2020; 37:434-440. [PMID: 33041492 PMCID: PMC7540637 DOI: 10.1055/s-0040-1715885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- James Jeffries
- Section of Interventional Radiology, Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Matthew Gayed
- Section of Interventional Radiology, Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Thuong G. Van Ha
- Section of Interventional Radiology, Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Rakesh Navuluri
- Section of Interventional Radiology, Department of Radiology, The University of Chicago, Chicago, Illinois
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Malignant Pleural Effusion: Diagnosis and Management. Can Respir J 2020; 2020:2950751. [PMID: 33273991 PMCID: PMC7695997 DOI: 10.1155/2020/2950751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/05/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022] Open
Abstract
Symptomatic malignant pleural effusion is a common clinical problem. This condition is associated with very high mortality, with life expectancy ranging from 3 to 12 months. Studies are contributing evidence on an increasing number of therapeutic options (therapeutic thoracentesis, thoracoscopic pleurodesis or thoracic drainage, indwelling pleural catheter, surgery, or a combination of these therapies). Despite the availability of therapies, the management of malignant pleural effusion is challenging and is mainly focused on the relief of symptoms. The therapy to be administered needs to be designed on a case-by-case basis considering patient's preferences, life expectancy, tumour type, presence of a trapped lung, resources available, and experience of the treating team. At present, the management of malignant pleural effusion has evolved towards less invasive approaches based on ambulatory care. This approach spares the patient the discomfort caused by more invasive interventions and reduces the economic burden of the disease. A review was performed of the diagnosis and the different approaches to the management of malignant pleural effusion, with special emphasis on their indications, usefulness, cost-effectiveness, and complications. Further research is needed to shed light on the current matters of controversy and help establish a standardized, more effective management of this clinical problem.
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30
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Bellini A, Tarrazzi F, Tami C, Patino SH, Block M. Intrapleural Fibrinolytic Therapy Improves Results With Talc Slurry Pleurodesis. Cureus 2020; 12:e10122. [PMID: 33005537 PMCID: PMC7523743 DOI: 10.7759/cureus.10122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective Talc slurry pleurodesis (TSP) can lead to permanent small loculations. Intrapleural tissue plasminogen activator (tPA) breaks down loculations, and therefore may improve results but may also inhibit pleurodesis. tPA was given with and after talc slurry to promote more uniform talc distribution and eliminate loculations. Methods Charts were reviewed for patients treated with TSP with or without tPA. Chest x-rays after TSP were compared to chest x-rays before and graded as "worse", "same", or "better". Incidence of need for repeat TSP was recorded. Results There were 52 patients, eight with bilateral effusions, for a study cohort of 60 effusions. One-third of the effusions were malignant. No patients experienced significant bleeding. Results were better than baseline for 14 (26%) patients given tPA, but not for patients that never received tPA. The addition of tPA 4-6 mg with talc slurry resulted in no patients requiring repeat TSP. When tPA was given after talc slurry, a delay of three days was associated with the lowest incidence of repeat TSP (3/14, 21%). Conclusions There were no significant complications from tPA use to supplement TSP, and tPA may improve results without interfering with pleurodesis. A prospective trial is warranted.
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Affiliation(s)
- Alyssa Bellini
- Department of Surgery, University of California Davis, Sacramento, USA
| | | | - Catherine Tami
- Division of Thoracic Surgery, Memorial Healthcare, Hollywood, USA
| | - Sanja H Patino
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Mark Block
- Division of Thoracic Surgery, Memorial Healthcare, Hollywood, USA
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31
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Yeung M, Loh EW, Tiong TY, Tam KW. Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis. Clin Exp Metastasis 2020; 37:541-549. [PMID: 32524317 DOI: 10.1007/s10585-020-10042-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023]
Abstract
Malignant pleural effusion (MPE) results from primary mesothelioma or the spreading of metastatic cancer. Both talc pleurodesis (TP) and indwelling pleural catheter (IPC) improve MPE symptoms. We performed a meta-analysis of randomized controlled trials to compare the efficacy of TP with that of IPC in patients with MPE. PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases were searched for studies published before February 2020. Individual effect sizes were standardized, and a meta-analysis was conducted to calculate a pooled effect size by using random effects models. In total, 4 trials with 500 patients were reviewed. Difference in pleurodesis success rate and change in dyspnea scores at 4 and 6 weeks between MPE patients treated with IPC and those treated with TP for pleurodesis were nonsignificant. The number of hospital inpatient days was significantly lower among patients who were treated with IPC (weight mean difference: 2.19; 95% confidence interval 0.70-3.67) than among those who were treated with TP. No significant difference was shown in adverse event profile between patients treated with IPC and those treated with TP for pleurodesis. In conclusion, both TP and IPC are equally effective in treating patients with MPE. The number of hospitalization days was significantly lower for patients who were treated with IPC, but the magnitude of the difference is of uncertain clinical importance.
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Affiliation(s)
- Maggie Yeung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - El-Wui Loh
- Centre for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tung-Yu Tiong
- Division of Thoracic Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Centre for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. .,Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. .,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Cochrane Taiwan, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Jany B, Welte T. Pleural Effusion in Adults-Etiology, Diagnosis, and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:377-386. [PMID: 31315808 DOI: 10.3238/arztebl.2019.0377] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 01/14/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pleural effusion is common in routine medical practice and can be due to many different underlying diseases. Precise differential diagnostic categorization is essential, as the treatment and prognosis of pleural effusion largely depend on its cause. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and on the authors' personal experience. RESULTS The most common causes of pleural effusion are congestive heart failure, cancer, pneumonia, and pulmonary embolism. Pleural fluid puncture (pleural tap) enables the differentiation of a transudate from an exudate, which remains, at present, the foundation of the further diagnostic work-up. When a pleural effusion arises in the setting of pneumonia, the potential devel- opment of an empyema must not be overlooked. Lung cancer is the most common cause of malignant pleural effusion, followed by breast cancer. Alongside the treatment of the underlying disease, the specific treatment of pleural effusion ranges from pleurodesis, to thoracoscopy and video-assisted thoracoscopy (with early consultation of a thoracic surgeon), to the placement of a permanently indwelling pleural catheter. CONCLUSION The proper treatment of pleural effusion can be determined only after meticulous differential diagnosis. The range of therapeutic options has recently become much wider. More data can be expected in the near future concerning diagnostic test- ing for the etiology of the effusion, better pleurodetic agents, the development of interventional techniques, and the genetic background of the affected patients.
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Affiliation(s)
- Berthold Jany
- Julius-Maximilians-Universität Würzburg, Klinikum Würzburg Mitte, Missioklinik, Department of Pneumology; Department of Respiratory Medicine, Hannover Medical School
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Bhatnagar R, Luengo-Fernandez R, Kahan BC, Rahman NM, Miller RF, Maskell NA. Thoracoscopy and talc poudrage compared with intercostal drainage and talc slurry infusion to manage malignant pleural effusion: the TAPPS RCT. Health Technol Assess 2020; 24:1-90. [PMID: 32525474 PMCID: PMC7307272 DOI: 10.3310/hta24260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There are around 40,000 new cases of malignant pleural effusion in the UK each year. Insertion of talc slurry via a chest tube is the current standard treatment in the UK. However, some centres prefer local anaesthetic thoracoscopy and talc poudrage. There is no consensus as to which approach is most effective. OBJECTIVE This trial tested the hypothesis that thoracoscopy and talc poudrage increases the proportion of patients with successful pleurodesis at 3 months post procedure, compared with chest drain insertion and talc slurry. DESIGN This was a multicentre, open-label, randomised controlled trial with embedded economic evaluation. Follow-up took place at 1, 3 and 6 months. SETTING This trial was set in 17 NHS hospitals in the UK. PARTICIPANTS A total of 330 adults with a confirmed diagnosis of malignant pleural effusion needing pleurodesis and fit to undergo thoracoscopy under local anaesthetic were included. Those adults needing a tissue diagnosis or with evidence of lung entrapment were excluded. INTERVENTIONS Allocation took place following minimisation with a random component, performed by a web-based, centralised computer system. Participants in the control arm were treated with a bedside chest drain insertion and 4 g of talc slurry. In the intervention arm, participants underwent local anaesthetic thoracoscopy with 4 g of talc poudrage. MAIN OUTCOME MEASURES The primary outcome measure was pleurodesis failure at 90 days post randomisation. Secondary outcome measures included mortality and patient-reported symptoms. A cost-utility analysis was also performed. RESULTS A total of 166 and 164 patients were allocated to poudrage and slurry, respectively. Participants were well matched at baseline. For the primary outcome, no significant difference in pleurodesis failure was observed between the treatment groups at 90 days, with rates of 36 out of 161 (22%) and 38 out of 159 (24%) noted in the poudrage and slurry groups, respectively (odds ratio 0.91, 95% confidence interval 0.54 to 1.55; p = 0.74). No differences (or trends towards difference) were noted in adverse events or any of the secondary outcomes at any time point, including pleurodesis failure at 180 days [poudrage 46/161 (29%), slurry 44/159 (28%), odds ratio 1.05, 95% confidence interval 0.63 to 1.73; p = 0.86], mean number of nights in hospital over 90 days [poudrage 12 nights (standard deviation 13 nights), slurry 11 nights (standard deviation 10 nights); p = 0.35] and all-cause mortality at 180 days [poudrage 66/166 (40%), slurry 68/164 (42%); p = 0.70]. At £20,000 per quality-adjusted life-year gained, poudrage would have a 0.36 probability of being cost-effective compared with slurry. LIMITATIONS Entry criteria specified that patients must be sufficiently fit to undergo thoracoscopy, which may make the results less applicable to those patients presenting with a greater degree of frailty. Furthermore, the trial was conducted on an open-label basis, which may have influenced the results of patient-reported measures. CONCLUSIONS The TAPPS (evaluating the efficacy of Thoracoscopy And talc Poudrage versus Pleurodesis using talc Slurry) trial has robustly demonstrated that there is no additional clinical effectiveness or cost-effectiveness benefit in performing talc poudrage at thoracoscopy over bedside chest drain and talc slurry for the management of malignant pleural effusion. TRIAL REGISTRATION Current Controlled Trials ISRCTN47845793. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 26. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | | | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
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Halford PJ, Bhatnagar R, White P, Haris M, Harrison RN, Holme J, Sivasothy P, West A, Bishop LJ, Stanton AE, Roberts M, Hooper C, Maskell NA. Manometry performed at indwelling pleural catheter insertion to predict unexpandable lung. J Thorac Dis 2020; 12:1374-1384. [PMID: 32395275 PMCID: PMC7212160 DOI: 10.21037/jtd.2020.02.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The finding of unexpandable lung (UL) at an early timepoint is of increasing importance in guiding treatment decisions in patients with malignant pleural effusion (MPE). Pleural manometry is the most common technique to delineate UL, however it has never been measured via an indwelling pleural catheter (IPC). To further the evidence base we analysed all patients in the IPC-PLUS study who had manometry performed during IPC insertion for the ability to predict substantial UL using manometry. Methods All patients enrolled in IPC-PLUS who had manometry performed at IPC insertion and radiographic assessment of UL at day 10 were included. Elastance curves were visually inspected for each patient. Initial pleural pressure, closing pleural pressure, and terminal elastance were analysed for their differences and predictive ability in those with substantial UL, defined as ≥25% entrapment on chest radiography. Results A total of 89 patients had manometry performed at IPC insertion with subsequent radiographic assessment of UL and interpretable elastance curves. Those with substantial UL had a significantly lower median closing pleural pressure (-15.00 vs. 0.00 cmH2O, P=0.012) and higher terminal elastance (12.03 vs. 8.59 cmH2O/L, P=0.021) compared to a combined group with no or partial UL. However, the predictive ability of these factors to discriminate substantial UL was poor, with areas under the receiver operating characteristic curves of 0.695 and 0.680 for closing pleural pressure and elastance respectively. Conclusions Our results suggest that manometry is not useful in accurately predicting substantial UL when used via an IPC at the time of insertion.
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Affiliation(s)
- Paul J Halford
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | - Paul White
- University of the West of England, Bristol, UK
| | - Mohammed Haris
- University Hospital of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Richard N Harrison
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, Manchester, UK
| | - Jayne Holme
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Alex West
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | | | - Mark Roberts
- Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK
| | - Clare Hooper
- Worcester Acute Hospitals NHS Trust, Worcester, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
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35
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Abbott DM, Bortolotto C, Benvenuti S, Lancia A, Filippi AR, Stella GM. Malignant Pleural Mesothelioma: Genetic and Microenviromental Heterogeneity as an Unexpected Reading Frame and Therapeutic Challenge. Cancers (Basel) 2020; 12:cancers12051186. [PMID: 32392897 PMCID: PMC7281319 DOI: 10.3390/cancers12051186] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/18/2022] Open
Abstract
Mesothelioma is a malignancy of serosal membranes including the peritoneum, pleura, pericardium and the tunica vaginalis of the testes. Malignant mesothelioma (MM) is a rare disease with a global incidence in countries like Italy of about 1.15 per 100,000 inhabitants. Malignant Pleural Mesothelioma (MPM) is the most common form of mesothelioma, accounting for approximately 80% of disease. Although rare in the global population, mesothelioma is linked to industrial pollutants and mineral fiber exposure, with approximately 80% of cases linked to asbestos. Due to the persistent asbestos exposure in many countries, a worldwide progressive increase in MPM incidence is expected for the current and coming years. The tumor grows in a loco-regional pattern, spreading from the parietal to the visceral pleura and invading the surrounding structures that induce the clinical picture of pleural effusion, pain and dyspnea. Distant spreading and metastasis are rarely observed, and most patients die from the burden of the primary tumor. Currently, there are no effective treatments for MPM, and the prognosis is invariably poor. Some studies average the prognosis to be roughly one-year after diagnosis. The uniquely poor mutational landscape which characterizes MPM appears to derive from a selective pressure operated by the environment; thus, inflammation and immune response emerge as key players in driving MPM progression and represent promising therapeutic targets. Here we recapitulate current knowledge on MPM with focus on the emerging network between genetic asset and inflammatory microenvironment which characterize the disease as amenable target for novel therapeutic approaches.
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Affiliation(s)
- David Michael Abbott
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy;
| | - Chandra Bortolotto
- Unit of Radiology, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy;
| | - Silvia Benvenuti
- Candiolo Cancer Institute, FPO—IRCCS—Str. Prov.le 142, km. 3,95—10060 Candiolo (TO), Italy;
| | - Andrea Lancia
- Unit of Radiation Therapy, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (A.L.); (A.R.F.)
| | - Andrea Riccardo Filippi
- Unit of Radiation Therapy, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (A.L.); (A.R.F.)
| | - Giulia Maria Stella
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy;
- Correspondence:
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Saleh ME, Awad G, Sanad M. Chemical pleurodesis for malignant pleural effusion: which agent is perfect? THE CARDIOTHORACIC SURGEON 2020. [DOI: 10.1186/s43057-020-00022-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pleurodesis is defined as symphysis between two layers of pleura to prevent recurrence of effusion, and it is the best available treatment for recurrent effusions of incurable malignancies. An ideal agent must be highly effective, safe, inexpensive, and readily available which is yet to be identified.
The aim of this study was to assess our results of medical pleurodesis, using 3 different chemical agents: bleomycin ampoules, doxycycline capsules, povidone–iodine solution, through two different routes, chest tube and small bore indwelling catheter.
Over a period of 5 years, 104 patients with malignant recurrent pleural effusion underwent pleurodesis at our university hospital, using 3 different agents and two routes of delivery.
Results
Fifty patients were male, patients’ age ranged from 22 to 74 years (57.55 ± 9.02). Fifty-nine patients (56.7%) had right-sided effusion, 61 patients (58.7%) had massive effusion. All patients were dyspneic. The rout of effusion drainage and sclerosing agent instillation was chest tube in 64 patients (61.5%) and small indwelling catheter in 40 patients. Forty-three patients received bleomycin, 36 patients received doxycycline, and 25 patients received povidone–iodine. The total success rate was 78.8%.
Conclusion
Pleurodesis is a safe acceptable palliative procedure for malignant pleural effusion with not yet definite ideal agent or rout. Hence, the availability and the expense of agent are important.
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Agrawal A, Murgu S. Multimodal approach to the management of malignant pleural effusions: role of thoracoscopy with pleurodesis and tunneled indwelling pleural catheters. J Thorac Dis 2020; 12:2803-2811. [PMID: 32642188 PMCID: PMC7330308 DOI: 10.21037/jtd.2020.03.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Malignant pleural effusion (MPE) is associated with a median survival of 3–6 months and causes significant symptoms affecting the overall quality of life in patients with advanced malignancies. Despite the high incidence of recurrent MPE, less than 25% of patients undergo a definitive pleural intervention as recommended by guidelines. In this review, we summarize the latest guidelines for management of MPE by various societies and discuss a multimodal approach in these patients using thoracoscopy with pleurodesis using talc insufflation and placement of tunneled indwelling pleural catheters (TIPC). We also address the role of diagnostic thoracoscopy for histologic and molecular diagnosis and outline our approach to patients with known or suspected MPE.
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Affiliation(s)
- Abhinav Agrawal
- Interventional Pulmonology, Section of Pulmonary & Critical Care, The University of Chicago Medicine, Chicago, IL, USA
| | - Septimiu Murgu
- Interventional Pulmonology, Section of Pulmonary & Critical Care, The University of Chicago Medicine, Chicago, IL, USA
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Valchev DG, Peeva KG. Postoperative survival time after video-assisted thoracic surgery: conventional and single-port for malignant pleural effusions. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.05023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dipper A, Jones HE, Bhatnagar R, Preston NJ, Maskell N, Clive AO. Interventions for the management of malignant pleural effusions: a network meta-analysis. Cochrane Database Syst Rev 2020; 4:CD010529. [PMID: 32315458 PMCID: PMC7173736 DOI: 10.1002/14651858.cd010529.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Malignant pleural effusion (MPE) is a common problem for people with cancer and usually associated with considerable breathlessness. A number of treatment options are available to manage the uncontrolled accumulation of pleural fluid, including administration of a pleurodesis agent (via a chest tube or thoracoscopy) or placement of an indwelling pleural catheter (IPC). This is an update of a review published in Issue 5, 2016, which replaced the original, published in 2004. OBJECTIVES To ascertain the optimal management strategy for adults with malignant pleural effusion in terms of pleurodesis success and to quantify differences in patient-reported outcomes and adverse effects between interventions. SEARCH METHODS We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid) and three other databases to June 2019. We screened reference lists from other relevant publications and searched trial registries. SELECTION CRITERIA We included randomised controlled trials of intrapleural interventions for adults with symptomatic MPE, comparing types of sclerosant, mode of administration and IPC use. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data on study design, characteristics, outcome measures, potential effect modifiers and risk of bias. The primary outcome was pleurodesis failure rate. Secondary outcomes were adverse events, patient-reported breathlessness control, quality of life, cost, mortality, survival, duration of inpatient stay and patient acceptability. We performed network meta-analyses of primary outcome data and secondary outcomes with enough data. We also performed pair-wise meta-analyses of direct comparison data. If we deemed interventions not jointly randomisable, or we found insufficient available data, we reported results by narrative synthesis. For the primary outcome, we performed sensitivity analyses to explore potential causes of heterogeneity and to evaluate pleurodesis agents administered via a chest tube only. We assessed the certainty of the evidence using GRADE. MAIN RESULTS We identified 80 randomised trials (18 new), including 5507 participants. We found all except three studies at high or unclear risk of bias for at least one domain. Due to the nature of the interventions, most studies were unblinded. Pleurodesis failure rate We included 55 studies of 21 interventions in the primary network meta-analysis. We estimated the rank of each intervention's effectiveness. Talc slurry (ranked 6, 95% credible interval (Cr-I) 3 to 10) is an effective pleurodesis agent (moderate certainty for comparison with placebo) and may result in fewer pleurodesis failures than bleomycin and doxycycline (bleomycin versus talc slurry: odds ratio (OR) 2.24, 95% Cr-I 1.10 to 4.68; low certainty; ranked 11, 95% Cr-I 7 to 15; doxycycline versus talc slurry: OR 2.51, 95% Cr-I 0.81 to 8.40; low certainty; ranked 12, 95% Cr-I 5 to 18). There is little evidence of a difference between the pleurodesis failure rate of talc poudrage and talc slurry (OR 0.50, 95% Cr-I 0.21 to 1.02; moderate certainty). Evidence for any difference was further reduced when restricting analysis to studies at low risk of bias (defined as maximum one high risk domain in the risk of bias assessment) (pleurodesis failure talc poudrage versus talc slurry: OR 0.78, 95% Cr-I 0.16 to 2.08). IPCs without daily drainage are probably less effective at obtaining a definitive pleurodesis (cessation of pleural fluid drainage facilitating IPC removal) than talc slurry (OR 7.60, 95% Cr-I 2.96 to 20.47; rank = 18/21, 95% Cr-I 13 to 21; moderate certainty). Daily IPC drainage or instillation of talc slurry via IPC are likely to reduce pleurodesis failure rates. Adverse effects Adverse effects were inconsistently reported. We performed network meta-analyses for the risk of procedure-related fever and pain. The evidence for risk of developing fever was of low certainty, but suggested there may be little difference between interventions relative to talc slurry (talc poudrage: OR 0.89, 95% Cr-I 0.11 to 6.67; bleomycin: OR 2.33, 95% Cr-I 0.45 to 12.50; IPCs: OR 0.41, 95% Cr-I 0.00 to 50.00; doxycycline: OR 0.85, 95% Cr-I 0.05 to 14.29). Evidence also suggested there may be little difference between interventions in the risk of developing procedure-related pain, relative to talc slurry (talc poudrage: OR 1.26, 95% Cr-I 0.45 to 6.04; very-low certainty; bleomycin: OR 2.85, 95% Cr-I 0.78 to 11.53; low certainty; IPCs: OR 1.30, 95% Cr-I 0.29 to 5.87; low certainty; doxycycline: OR 3.35, 95% Cr-I 0.64 to 19.72; low certainty). Patient-reported control of breathlessness Pair-wise meta-analysis suggests there is likely no difference in breathlessness control, relative to talc slurry, of talc poudrage ((mean difference (MD) 4.00 mm, 95% CI -6.26 to 14.26) on a 100 mm visual analogue scale for breathlessness; studies = 1; participants = 184; moderate certainty) and IPCs without daily drainage (MD -6.12 mm, 95% CI -16.32 to 4.08; studies = 2; participants = 160; low certainty). Overall mortality There may be little difference between interventions when compared to talc slurry (bleomycin and IPC without daily drainage; low certainty) but evidence is uncertain for talc poudrage and doxycycline. Patient acceptability Pair-wise meta-analysis demonstrated that IPCs probably result in a reduced risk of requiring a repeat invasive pleural intervention (OR 0.25, 95% Cr-I 0.13 to 0.48; moderate certainty) relative to talc slurry. There is likely little difference in the risk of repeat invasive pleural intervention with talc poudrage relative to talc slurry (OR 0.96, 95% CI 0.59 to 1.56; moderate certainty). AUTHORS' CONCLUSIONS Based on the available evidence, talc poudrage and talc slurry are effective methods for achieving a pleurodesis, with lower failure rates than a number of other commonly used interventions. IPCs provide an alternative approach; whilst associated with inferior definitive pleurodesis rates, comparable control of breathlessness can probably be achieved, with a lower risk of requiring repeat invasive pleural intervention. Local availability, global experience of agents and adverse events (which may not be identified in randomised trials) and patient preference must be considered when selecting an intervention. Further research is required to delineate the roles of different treatments according to patient characteristics, such as presence of trapped lung. Greater attention to patient-centred outcomes, including breathlessness, quality of life and patient preference is essential to inform clinical decision-making. Careful consideration to minimise the risk of bias and standardise outcome measures is essential for future trial design.
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Affiliation(s)
| | - Hayley E Jones
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | | | - Nancy J Preston
- Lancaster UniversityInternational Observatory on End of Life CareFurness CollegeLancasterUKLA1 4YG
| | - Nick Maskell
- University of BristolAcademic Respiratory UnitBristolUK
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Hassan M, Gadallah M, Mercer RM, Harriss E, Rahman NM. Predictors of outcome of pleurodesis in patients with malignant pleural effusion: a systematic review and meta-analysis. Expert Rev Respir Med 2020; 14:645-654. [PMID: 32213100 DOI: 10.1080/17476348.2020.1746647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives: Pleurodesis is an important management option to palliate breathlessness in patients with malignant pleural effusion (MPE). This systematic review aimed to examine available literature for studies investigating factors that predict pleurodesis outcome.Methods: The healthcare databases advanced search (HDAS) Medline and Embase in addition to Cochrane Database of Systematic Reviews were searched on for publications reporting on pleurodesis for MPE in English language. All study types reporting previously unpublished data on predictors of pleurodesis success were included. Thirty-four studies involving 4626 patients were included in the systematic review.Results: The most common pleurodesis agent used was talc which was used in 27 studies. Meta-analyses demonstrated that the strongest predictors of pleurodesis success were higher pleural fluid pH, smaller volume of effusion pre-pleurodesis and full lung re-expansion post effusion drainage. Shorter duration of tube drainage, higher pleural fluid glucose, lower LDH, and lower pleural tumor burden all seem to favor pleurodesis success, but with considerable statistical heterogeneity between studies. Available data do not suggest that chest tube size affects pleurodesis outcome.Conclusion: Overall, available results are difficult to interpret due to evidence quality. Prospective studies are needed to further explore these factors.Protocol registration: CRD42018115874 (Prospero database of systematic reviews).
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Affiliation(s)
- Maged Hassan
- Chest Diseases Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Mohamed Gadallah
- Chest Diseases Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Rachel M Mercer
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Elinor Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
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Takemoto S, Fukuda M, Yamaguchi H, Ikeda T, Akagi K, Tomono H, Umeyama Y, Dotsu Y, Taniguchi H, Gyotoku H, Senju H, Kitazaki T, Nakatomi K, Nagashima S, Fukuda M, Kinoshita A, Soda H, Mukae H. Phase II study of ramucirumab and docetaxel for previously treated non-small cell lung cancer patients with malignant pleural effusion: Protocol of PLEURAM study. Thorac Cancer 2020; 11:389-393. [PMID: 31851428 PMCID: PMC6996979 DOI: 10.1111/1759-7714.13279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Anti-vascular endothelial growth factor therapy has been shown to be effective in non-small cell lung cancer (NSCLC) patients with malignant pleural effusion (MPE); however, there are no data to suggest that ramucirumab has the same effects. METHODS We therefore decided to conduct a phase II study of ramucirumab plus docetaxel for NSCLC patients with MPE. The MPE control rate at eight weeks after the start of treatment will be the primary endpoint, and the objective response rate, progression-free survival, one-year survival rate, overall survival, and toxicity profile will be secondary endpoints. DISCUSSION A previous study indicated that administering chemotherapy in combination with bevacizumab was effective at controlling pleural effusion in patients with NSCLC with carcinomatous pleurisy. It is expected that ramucirumab will have a similar effect to the same group.
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Affiliation(s)
- Shinnosuke Takemoto
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Minoru Fukuda
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Clinical Oncology CenterNagasaki University HospitalNagasakiJapan
| | - Hiroyuki Yamaguchi
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Takaya Ikeda
- Department of Thoracic OncologyNational Cancer Center Hospital EastKashiwaJapan
| | - Kazumasa Akagi
- Department of Respiratory MedicineNagasaki Prefecture Shimabara HospitalShimabaraJapan
| | - Hiromi Tomono
- Department of Respiratory MedicineSasebo City General HospitalSaseboJapan
| | - Yasuhiro Umeyama
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Yosuke Dotsu
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Hirokazu Taniguchi
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Hiroshi Gyotoku
- Department of Respiratory MedicineNational Hospital Organization Nagasaki Medical CenterOhmuraJapan
| | - Hiroaki Senju
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Takeshi Kitazaki
- Division of Respiratory Diseases, Department of Internal MedicineJapanese Red Cross Nagasaki Genbaku HospitalNagasakiJapan
| | - Katsumi Nakatomi
- Department of Respiratory MedicineNational Hospital Organization Ureshino Medical CenterUreshinoJapan
| | - Seiji Nagashima
- Department of Respiratory MedicineNational Hospital Organization Nagasaki Medical CenterOhmuraJapan
| | - Masaaki Fukuda
- Division of Respiratory Diseases, Department of Internal MedicineJapanese Red Cross Nagasaki Genbaku HospitalNagasakiJapan
| | - Akitoshi Kinoshita
- Department of Respiratory MedicineNagasaki Prefecture Shimabara HospitalShimabaraJapan
| | - Hiroshi Soda
- Department of Respiratory MedicineSasebo City General HospitalSaseboJapan
| | - Hiroshi Mukae
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
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Zarogoulidis P, Huang H, Yang M, Zhou J, Jiao Y, Wang Q, Petridis D, Sapalidis K, Sardeli C, Konsta P, Koulouris C, Michalopoulos N, Giannakidis D, Barbetakis N, Katsaounis A, Hohenforst-Schmidt W, Amaniti A, Petanidis S, Tsakiridis K, Courcoutsakis N, Goganau AM, Vagionas A, Romanidis K, Oikonomou P, Karanikas M, Katsios IN, Kesisoglou I, Kosmidis C. Pleurodesis and Immunotherapy in NSCLC; Medical Thoracoscopy or VATS? J Cancer 2020; 11:1606-1613. [PMID: 32047566 PMCID: PMC6995373 DOI: 10.7150/jca.40004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/29/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction: Immunotherapy is a treatment option for non-small cell lung cancer advanced disease. However; immunotherapy in several patients induces orogonitis and effusion in different cavities. It is up to the treating physician to understand whether there is effusion due to adverse effect or disease progression. Pleurodesis in both cases might be a solution for recurrent pleura effusion. Patients and Methods: Three hundred and thirty seven non-small cell lung cancer patients with adenocarcinoma and pleura effusion during first line immunotherapy treatment underwent medical thoracoscopy or Video assisted thoracic surgery (VATS) for pleurodesis with talk poudrage. Uniportal medical thoracoscopy was performed under general with dual channel endotracheal tube in one hundred and eleven patients. Video assisted thoracic surgery was performed in one hundred and eighty seven patients and conversion from medical to VATS procedure was done to thirty nine patients. All patients had stage IV disease with pleura involvement and were under first line pembrolizumab treatment with 200mg (PD-L1 ≥ 50%). Results: The quantitative parameters of the study (expression, PY and cycle) were converted to an ordinal scale to facilitate the performance of statistical analysis. All parameters were examined as dependent against the parameter technique acting as independent to detect potential relationships. The results of multi Y versus X relationship revealed no statistically significant effect (p>0.05) of the three levels of technique against any response considered. Thus we can infer, quite safely, that the innovative operation (level 0) does not differ from the other two conventional methods (levels 2 and 3) through all parameters entered in the model. There was no significant difference between the different pleurodesis techniques. Discussion: Immunotherapy is known to induce in a number of patients pleura effusion and pericarditis. However; pleurodesis is efficient when the appropriate method is performed to every patient. Careful assessment in a case by case manner has to be performed for each patient before any procedure is performed.
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Affiliation(s)
- Paul Zarogoulidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, P. R. China
| | - Meng Yang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, P. R. China
| | - Jun Zhou
- Department of Respiratory, Changzhou 1st People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, P.R. China
| | - Yang Jiao
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, P. R. China
| | - Qin Wang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, P. R. China
| | - Dimitris Petridis
- Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece
| | - Konstantinos Sapalidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Chrysanthi Sardeli
- Department of Pharmacology & Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Parthenopi Konsta
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Charilaos Koulouris
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Nikolaos Michalopoulos
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Dimitrios Giannakidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Nikolaos Barbetakis
- Thoracic Surgery Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece
| | - Athanasios Katsaounis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, "Hof" Clinics, University of Erlangen, Hof, Germany
| | - Aikaterini Amaniti
- Anesthisiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Savvas Petanidis
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University, Moscow, 119992, Russian Federation
| | - Kosmas Tsakiridis
- Thoracic Surgery Department, Interbalkan ``European`` Medical Center, Thessaloniki, Greece
| | - Nikolaos Courcoutsakis
- Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandru Marian Goganau
- General Surgery Clinic 1, University of Medicine and Pharmacy of Craiova, Craiova County Emergency Hospital, Craiova, Romania
| | | | - Konstantinos Romanidis
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagoula Oikonomou
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael Karanikas
- Department of Surgery, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Iason Nikolaos Katsios
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Isaak Kesisoglou
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Christoforos Kosmidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
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Chen F, Dai L, An J, Zeng N, Chen L, Shen Y. Diagnostic accuracy of E-cadherin for malignanteffusions: a systematic review and meta-analysis. Postgrad Med J 2019; 96:530-536. [PMID: 31818872 DOI: 10.1136/postgradmedj-2019-137025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/17/2019] [Accepted: 11/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The differential diagnosis of malignant effusion remains a clinical challenge. We aim to summarise all relevant literature studies in order to determine the overall clinical value of E-cadherin in the diagnosis of malignant effusion by meta-analysis. METHODS PubMed, the Cochrane Library Database, Medline (Ovid), Web of Science, CNKI, WANFANG and WEIPU databases are thoroughly searched up to 15 March2018. The calculated pooled sensitivity, specificity, likelihood ratio (LR), diagnostic OR(DOR) and the summary receiver operating characteristic (SROC) curve were plotted. RESULTS A total of 15 studies were included in the analysis. The sensitivity and specificity of E-cadherin in the diagnosis of malignant effusion were determined to be high, with a sensitivity of 0.83(95%CI0.79 to 0.87) and a specificity of 0.96(95%CI0.90 to 0.98). The positive LR was determined to be 21.10(95%CI 8.54 to 52.11), the negative LR was determined to be 0.17(95% CI 0.14 to 0.22) and the DOR was determined to be 121.34(95%CI 49.11 to 299.80). The SROC curve exhibited a high overall diagnostic, with the area under the curve measured to be 0.91(95% CI 0.89 to 0.93). Subgroup analysis showed the method (cell blocks or smears), sample size (≥100 or<100), geographical location (Asia, Europe or USA) and impact factor of each article (≥3 or<3) were not the sources of overall heterogeneity. CONCLUSION E-cadherin exhibits very good diagnostic accuracy for the diagnosis for malignant effusion; thus, it can be helpful in the process of clinical decisions.
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Affiliation(s)
- Fangying Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.,Department of Tuberculosis, The Third People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China
| | - Luqi Dai
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Jing An
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Ni Zeng
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China ,
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China ,
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Frost N, Brünger M, Ruwwe-Glösenkamp C, Raspe M, Tessmer A, Temmesfeld-Wollbrück B, Schürmann D, Suttorp N, Witzenrath M. Indwelling pleural catheters for malignancy-associated pleural effusion: report on a single centre's ten years of experience. BMC Pulm Med 2019; 19:232. [PMID: 31791305 PMCID: PMC6888898 DOI: 10.1186/s12890-019-1002-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Recurrent pleural effusion is a common cause of dyspnoea, cough and chest pain during the course of malignant diseases. Chemical pleurodesis had been the only definitive treatment option until two decades ago. Indwelling pleural catheters (IPC) emerged as an alternative, not only assuring immediate symptom relief but also potentially leading to pleurodesis in the absence of sclerosing agents. Methods In this single-centre retrospective observational study patient characteristics, procedural variables and outcome in a large population of patients with IPC in malignancy were evaluated and prognostic factors for pleurodesis were identified. Results From 2006 to 2016, 395 patients received 448 IPC, of whom 121 (30.6%) had ovarian, 91 (23.0%) lung and 45 (11.4%) breast cancer. The median length of IPC remaining in place was 1.2 months (IQR, 0.5–2.6), the median survival time after insertion 2.0 months (IQR, 0.6–6.4). An adequate symptom relief was achieved in 94.9% of all patients, with no need for subsequent interventions until last visit or death. In patients surviving ≥30 days after IPC insertion, pleurodesis was observed in 44.5% and was more common in patients < 60 years (HR, 1.72; 95% CI, 1.05–2.78; p = 0.03). The use of an additional talc slurry via the IPC was highly predictive for pleurodesis (HR 6.68; 95% CI, 1.44–31.08; p = 0.02). Complications occurred in 13.4% of all procedures (n = 60), 41.8% concerning infections (local infections at the tunnel/exit site (n = 14) and empyema (n = 11)), and 98.3% being low or mild grade (n = 59). Complication rates were higher in men than women (18.6 vs. 12.4%, p = 0.023). Conclusion High efficacy in symptom relief and a favourable safety profile confirm IPC as suitable first line option in most malignant pleural effusions. The study presents the largest dataset on IPC in gynaecologic cancer to date. Gender-specific differences in complication rates warrant further study.
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Affiliation(s)
- Nikolaj Frost
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353, Berlin, Germany.
| | - Martin Brünger
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph Ruwwe-Glösenkamp
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - Matthias Raspe
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - Antje Tessmer
- Klinik für Pneumologie - Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Bettina Temmesfeld-Wollbrück
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - Dirk Schürmann
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353, Berlin, Germany.,Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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45
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Shpanskaya K, Lungren MP, Tulin-Silver S. Pediatric Interventional Oncology: Endovascular, Percutaneous, and Palliative Procedures. Semin Roentgenol 2019; 54:359-366. [PMID: 31706369 DOI: 10.1053/j.ro.2019.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | - Matthew P Lungren
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA
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46
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Sagar AES, Dodge DL, Salahuddin M, Warner MT, Mak G, Faiz SA. Pleural Diseases: Pleurodesis via Indwelling Pleural Catheter, Dasatinib-induced Pleural Effusion, and IL-27 in Tuberculosis Pleural Effusion. Am J Respir Crit Care Med 2019; 200:771-773. [PMID: 31246494 PMCID: PMC6775873 DOI: 10.1164/rccm.201810-2058rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/26/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ala-Eddin S. Sagar
- Division of Critical Care, Pulmonary, and Sleep Medicine, McGovern Medical School at University of Texas Health Science Center, Houston, Texas; and
| | - Daniel L. Dodge
- Division of Critical Care, Pulmonary, and Sleep Medicine, McGovern Medical School at University of Texas Health Science Center, Houston, Texas; and
| | - Moiz Salahuddin
- Division of Critical Care, Pulmonary, and Sleep Medicine, McGovern Medical School at University of Texas Health Science Center, Houston, Texas; and
| | - Mark T. Warner
- Division of Critical Care, Pulmonary, and Sleep Medicine, McGovern Medical School at University of Texas Health Science Center, Houston, Texas; and
| | - Garbo Mak
- Division of Critical Care, Pulmonary, and Sleep Medicine, McGovern Medical School at University of Texas Health Science Center, Houston, Texas; and
| | - Saadia A. Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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47
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Hsu LH, Feng AC, Soong TC, Ko JS, Chu NM, Lin YF, Kao SH. Clinical outcomes of chemical pleurodesis using a minocycline. Ther Adv Respir Dis 2019; 13:1753466619841231. [PMID: 30945619 PMCID: PMC6454655 DOI: 10.1177/1753466619841231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Pleurodesis is often used to prevent the re-accumulation of a malignant
pleural effusion (MPE). Intrapleural urokinase (IPUK) therapy facilitates
lung re-expansion for patients with loculated MPE or a trapped lung that
allows subsequent pleurodesis. MPE management has been traditionally
regarded as a symptomatic treatment. We tried to evaluate their impact on
patient survival. Methods: There were 314 consecutive patients with symptomatic MPE that underwent
minocycline pleurodesis with (n = 109) and without
(n = 205) the antecedent IPUK therapy between September
2005 and August 2015, who were recruited for the pleurodesis outcome and
survival analysis. Results: The rate of successful pleurodesis was similar between the simple pleurodesis
group and the IPUK therapy group followed by the pleurodesis group (69.0%
versus 70.5%; p = 0.804). The patients
who succeeded pleurodesis had a longer survival rate than those who failed
in either the simple pleurodesis group (median, 414 versus
100 days; p < 0.001) or the IPUK therapy followed by
pleurodesis group (259 versus 102 days; p
< 0.001). The survival differences remained when the lung and breast
cancer patients were studied separately. Conclusion: Successful pleurodesis translated into a better survival rate that promotes
performing pleurodesis on lung re-expansion. The apparent shorter survival
of the patients with loculated MPE or trapped lung, and those that did not
respond to the IPUK therapy, lowered the probability of the survival benefit
through the simple physical barrier by the fibrin formation to prevent the
tumor spreading. The successfully induced inflammatory response by
minocycline is supposed to prohibit the tumor invasion and metastasis.
Further studies are warranted to clarify the mechanism and provide
opportunities to develop novel therapeutic strategies.
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Affiliation(s)
- Li-Han Hsu
- PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei.,Division of Pulmonary and Critical Care Medicine, Sun Yat-Sen Cancer Center, Taipei.,Department of Medicine, National Yang-Ming University Medical School, Taipei
| | - An-Chen Feng
- Department of Research, Sun Yat-Sen Cancer Center, Taipei
| | - Thomas C Soong
- Department of Radiology, Sun Yat-Sen Cancer Center, Taipei
| | - Jen-Sheng Ko
- Department of Pathology, Sun Yat-Sen Cancer Center, Taipei
| | - Nei-Min Chu
- Department of Medical Oncology, Sun Yat-Sen Cancer Center, Taipei
| | - Yung-Feng Lin
- PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei.,School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei
| | - Shu-Huei Kao
- PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University; School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110
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48
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Epelbaum O, Rahman NM. Contemporary approach to the patient with malignant pleural effusion complicating lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:352. [PMID: 31516898 DOI: 10.21037/atm.2019.03.61] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Malignant pleural effusion (MPE) occurring in the patient with lung cancer can have profound prognostic and management implications. If clinically relevant, such an effusion first needs to be confirmed as malignant and then, in the majority of lung cancer patients, it will require a pleural intervention to relieve symptoms related to fluid accumulation. The field of pleural diseases in general, and pleural malignancy in particular, has undergone dynamic changes in recent years as the evidence base informing practice has grown by leaps and bounds. Both the diagnosis and management of MPE are dynamically changing disciplines in thoracic medicine. As commonly happens, emerging data have generated just as many questions as they have answered. The aim of the present review is to summarize the current knowledge about MPE resulting from lung cancer in a manner that is accessible to clinicians across medical specialties.
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Affiliation(s)
- Oleg Epelbaum
- Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Respiratory Trials Unit, Oxford University, Oxford, UK
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49
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Beck TN, Deneka AY, Chai L, Kanach C, Johal P, Alvarez NJ, Boumber Y, Golemis EA, Laub GW. An improved method of delivering a sclerosing agent for the treatment of malignant pleural effusion. BMC Cancer 2019; 19:614. [PMID: 31234819 PMCID: PMC6589887 DOI: 10.1186/s12885-019-5777-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/30/2019] [Indexed: 12/26/2022] Open
Abstract
Background Malignant pleural effusion (MPE) is a devastating sequela associated with cancer. Talc pleurodesis is a common treatment strategy for MPE but has been estimated to be unsuccessful in up to 20–50% of patients. Clinical failure of talc pleurodesis is thought to be due to poor dispersion. This monograph reports the development of a foam delivery system designed to more effectively coat the pleural cavity. Methods C57BL/6 mice were injected with Lewis lung carcinoma (LL/2) cells intrapleurally to induce MPE. The mice then received either normal saline (NS) control, foam control (F), talc slurry (TS, 2 mg/g) or talc foam (TF, 2 mg/g). Airspace volume was evaluated by CT, lungs/pleura were collected, and percent fibrosis was determined. Results The TF group had significantly better survival than the TS group (21 vs 13.5 days, p < 0.0001). The average effusion volume was less in the talc groups compared to the control group (140 vs 628 μL, p < 0.001). TF induced significant lung fibrosis (p < 0.01), similar to TS. On CT, TF significantly (p < 0.05) reduced loss of right lung volume (by 30–40%) compared to the control group. This was not seen with TS (p > 0.05). Conclusions This report describes using a novel talc foam delivery system for the treatment of MPE. In the LL/2 model, mice treated with the TF had better survival outcomes and less reduction of lung volume than mice treated with the standard of care TS. These data provide support for translational efforts to move talc foam from animal models into clinical trials.
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Affiliation(s)
- Tim N Beck
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA. .,Digestive Disease & Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Alexander Y Deneka
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA.,Department of Biochemistry, Kazan Federal University, Kazan, Russia
| | - Louis Chai
- Department of Cardiothoracic Surgery, Drexel University College of Medicine, Hahnemann University Hospital, 230 North Broad Street, Philadelphia, PA, 19102, USA
| | - Colin Kanach
- Department of Pathology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA
| | - Priya Johal
- Department of Pathology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA
| | - Nicolas J Alvarez
- Department of Chemical and Biological Engineering, Drexel University, Philadelphia, PA, 19129, USA
| | - Yanis Boumber
- Department of Biochemistry, Kazan Federal University, Kazan, Russia.,Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Erica A Golemis
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Glenn W Laub
- Department of Cardiothoracic Surgery, Drexel University College of Medicine, Hahnemann University Hospital, 230 North Broad Street, Philadelphia, PA, 19102, USA.
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50
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闵 诗, 郑 强, 张 白, 严 丹, 王 汝, 瞿 子, 李 潞, 刘 洁, 周 清. [A Meta-Analysis of Efficacy and Adverse Effects of Lobaplatin and Cisplatin in the Treatment of Malignant Pleural Effusion]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:90-98. [PMID: 30827325 PMCID: PMC6397937 DOI: 10.3779/j.issn.1009-3419.2019.02.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 01/29/2019] [Accepted: 02/11/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study is to systematically evaluate the efficacy and adverse effects of Lobaplatin and Cisplatin in the treatment of malignant pleural effusion. METHODS The databases of Medline (PubMed), Embase, Web of Science, Cochrane, Wanfang, CNKI and VIP were retrieved so as to search the studies about the randomized controlled clinical trials (RCT) that compared the Lobaplatin and Cisplatin for malignant pleural effusion. The main outcome indicators include objective response rate, complete response, partial response, nephrotoxicity, chest pain, gastrointestinal reaction, myelosuppression, fever response and hepatotoxicity. Relative risk was used as the effect size, which was expressed as 95% confidence interval. The meta-analysis was performed using Stata 14.0 statistical software. RESULTS A total of 12 RCTs and 720 MPE patients were included. The results showed that the ORR (RR=1.27, 95%CI: 1.15-1.40, P<0.001), CR (RR=1.39, 95%CI: 1.09-1.78, P=0.007), PR (RR=1.21, 95%CI: 1.02-1.42, P=0.026) in LBP thoracic perfusion chemotherapy were significantly higher than those in DDP thoracic perfusion chemotherapy. The incidence of nephrotoxicity (RR=0.31, 95%CI: 0.13-0.71, P=0.005) and gastrointestinal reactions (RR=0.44, 95%CI: 0.31-0.62, P<0.001) in the LBP group were significantly lower than those in DDP group. CONCLUSIONS Compared with DDP pleural perfusion chemotherapy, the ORR, CR and PR of LBP pleural perfusion chemotherapy for MPE are significantly better than DDP, and its nephrotoxicity and gastrointestinal reactions are remarkably lower than DDP.
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Affiliation(s)
- 诗惠 闵
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 强强 郑
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 白露 张
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 丹丽 严
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 汝兰 王
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 子涵 瞿
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 潞 李
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 洁薇 刘
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 清华 周
- 610041 成都,四川大学华西医院肺癌中心Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- 300052 天津,天津医科大学总医院天津市肺癌研究所Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
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