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Talebzadeh H, Nazari Sabet M. Comparison between pleurodesis results by 50% glucose solution, versus Bleomycin pleurodesis in patients with malignant pleural effusion. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2023; 15:134-141. [PMID: 38022726 PMCID: PMC10658074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/07/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Following parapneumonic effusions, malignant pleural effusions (MPEs) stand as the second most common cause of exudative pleural effusions. These effusions typically remain unresponsive to systemic chemotherapy, necessitating novel therapeutic approaches. This study aims to ascertain the effectiveness of intrapleural injection with a 50% glucose solution and to compare it with intrapleural injection of Bleomycin sulfate in treating malignant pleural effusion. METHODS This prospective, double-blind, randomized clinical trial was conducted at Al-Zahra Hospital in Isfahan. The study protocol gained approval from the Iranian Registry of Clinical Trials (IRCT code: IRCT20201013049017N1) (https://en.irct.ir/trial/52739). The study population encompassed patients with malignant pleural effusion. Sampling occurred through a census approach from October 2019 to March 2020. The first group received a pleurodesis solution containing 12.5 cc of 2% lidocaine with Bleomycin, while the second group received a solution comprising 200 cc of 50% glucose solution (10 grams of glucose) and 12.5 ml of 2% lidocaine, within the same volume. These solutions were injected into the pleural space via the chest tube. RESULTS The complete response rate to treatment three months post-injection was 71.9% in the Bleomycin sulfate group and 65.6% in the 50% dextrose group. However, the difference between the two groups did not achieve statistical significance (P = 0.689). The incidence of post-injection fever and pain intensity exhibited comparability in both groups. CONCLUSION The treatment involving a combination of 50% glucose solution with Bleomycin for pleurodesis in patients with malignant pleural effusion demonstrated outcomes akin to other treatment options.
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Affiliation(s)
- Hamid Talebzadeh
- Department of Thoracic Surgery, Anesthesiology and Critical Care Research Center, Isfahan University of Medical SciencesIsfahan, Iran
| | - Milad Nazari Sabet
- Department of General Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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Wu YY, Hsu YL, Huang YC, Su YC, Wu KL, Chang CY, Ong CT, Lai JC, Shen TY, Lee TH, Hung JY, Tsai YM. Characterization of the pleural microenvironment niche and cancer transition using single-cell RNA sequencing in EGFR-mutated lung cancer. Theranostics 2023; 13:4412-4429. [PMID: 37649596 PMCID: PMC10465223 DOI: 10.7150/thno.85084] [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: 04/07/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Background: Lung cancer is associated with a high mortality rate and often complicated with malignant pleural effusion (MPE), which has a very poor clinical outcome with a short life expectancy. However, our understanding of cell-specific mechanisms underlying the pathobiology of pleural metastasis remains incomplete. Methods: We analyzed single-cell transcriptomes of cells in pleural effusion collected from patients with lung cancer and congestive heart failure (as a control), respectively. Soluble and complement factors were measured using a multiplex cytokine bead assay. The role of ferroptosis was evaluated by GPX4 small interfering RNA (siRNA) transfection and overexpression. Results: We found that the mesothelial-mesenchymal transition (MesoMT) of the pleural mesothelial cells contributed to pleural metastasis, which was validated by lung cancer/mesothelial cell co-culture experiments. The ferroptosis resistance that protected cancer from death which was secondary to extracellular matrix detachment was critical for pleural metastasis. We found a universal presence of immune-suppressive lipid-associated tumor-associated macrophages (LA-TAMs) with complement cascade alteration in the MPE of the lung cancer patients. Specifically, upregulated complement factors were also found in the MPE, and C5 was associated with poor overall survival in the lung cancer patients with epidermal growth factor receptor mutation. Plasmacytoid dendritic cells (pDCs) exhibited a dysfunctional phenotype and pro-tumorigenic feature in the primary cancer. High expression of the gene set extracted from pDCs was associated with a poor prognosis in the lung cancer patients. Receptor-ligand interaction analysis revealed that the pleural metastatic niche was aggravated by cross-talk between mesothelial cells-cancer cells/immune cells via TNC and ICAM1. Conclusions: Taken together, our results highlight cell-specific mechanisms involved in the pathobiological development of pleural metastasis in lung cancer. These results provide a large-scale and high-dimensional characterization of the pleural microenvironment and offer a useful resource for the future development of therapeutic drugs in lung cancer.
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Affiliation(s)
- Yu-Yuan Wu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ya-Ling Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yung-Chi Huang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yue-Chiu Su
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Kuan-Li Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Post Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chao-Yuan Chang
- Department of Anatomy, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chai-Tung Ong
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Fragrance and Cosmetic Science, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jia-Chen Lai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Tzu-Yen Shen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Tai-Huang Lee
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 807, Taiwan
| | - Jen-Yu Hung
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 807, Taiwan
| | - Ying-Ming Tsai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Li Q, Hu C, Su S, Ma Z, Geng Y, Hu Y, Jin H, Li H, Lu B. Impact of thoracic tumor radiotherapy on survival in non-small-cell lung cancer with malignant pleural effusion treated with targeted therapy: Propensity score matching study. Cancer Med 2023; 12:14949-14959. [PMID: 37288833 PMCID: PMC10417183 DOI: 10.1002/cam4.6130] [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: 03/14/2023] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND EGFR-mutant (EGFR-M) and ALK-positive (ALK-P)are common in malignant pleural effusion (MPE) with metastatic non-small-cell lung cancer (NSCLC) (MPE-NSCLC). The impact of thoracic tumor radiotherapy on survival in such patients remains unclear. We aimed to investigate whether thoracic tumor radiotherapy could improve overall survival (OS) in such patients. METHODS According to whether or not patients accepted thoracic tumor radiotherapy, 148 patients with EGFR-M or ALK-P MPE-NSCLC treated with targeted therapy were classified into two groups: DT group without thoracic tumor radiotherapy and DRT group with thoracic tumor radiotherapy. Propensity score matching (PSM) was performed to balance clinical baseline characteristics. Overall survival was analyzed by Kaplan-Meier, compared by log-rank test, and evaluated using Cox proportional hazards model. RESULTS Median survival time (MST) was 25 months versus 17 months in the DRT group and DT group. The OS rates at 1, 2, 3, 5 years in the DRT group and DT group were 75.0%, 52.8%, 26.8%, 11.1% and 64.5%, 28.4%, 9.2%, 1.8%, respectively (χ2 = 12.028, p = 0.001). Compared with DT group, the DRT group still had better survival after PSM (p = 0.007). Before and after PSM, factors associated with better OS through multivariable analysis were that thoracic tumor radiotherapy, radiotherapy, N0-2 , and ALK-TKIs. Grades 4-5 radiation toxicities were not observed in patients; 8 (11.6%) and 7 (10.1%) out of the DRT group suffered from Grade 3 radiation esophagitis and radiation pneumonitis, respectively. CONCLUSION Our results for EGFR-M or ALK-P MPE-NSCLC showed that thoracic tumor radiotherapy may be crucial factor in improving OS with acceptable toxicities. Potential biases should not be neglected: Further randomized controlled trials are necessary to confirm this result.
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Affiliation(s)
- Qingsong Li
- Department of Thoracic OncologyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
- Department of Thoracic OncologyAffiliated Cancer Hospital of Guizhou Medical UniversityGuiyangChina
- Teaching and Research Department of OncologyClinical Medical College of Guizhou Medical UniversityGuiyangChina
| | - Cheng Hu
- Department of Thoracic OncologyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
- Department of Thoracic OncologyAffiliated Cancer Hospital of Guizhou Medical UniversityGuiyangChina
- Teaching and Research Department of OncologyClinical Medical College of Guizhou Medical UniversityGuiyangChina
| | - Shengfa Su
- Department of Thoracic OncologyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
- Department of Thoracic OncologyAffiliated Cancer Hospital of Guizhou Medical UniversityGuiyangChina
- Teaching and Research Department of OncologyClinical Medical College of Guizhou Medical UniversityGuiyangChina
| | - Zhu Ma
- Department of Thoracic OncologyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
- Department of Thoracic OncologyAffiliated Cancer Hospital of Guizhou Medical UniversityGuiyangChina
| | - Yichao Geng
- Department of Thoracic OncologyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
- Department of Thoracic OncologyAffiliated Cancer Hospital of Guizhou Medical UniversityGuiyangChina
- Teaching and Research Department of OncologyClinical Medical College of Guizhou Medical UniversityGuiyangChina
| | - Yinxiang Hu
- Department of Thoracic OncologyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
- Department of Thoracic OncologyAffiliated Cancer Hospital of Guizhou Medical UniversityGuiyangChina
- Teaching and Research Department of OncologyClinical Medical College of Guizhou Medical UniversityGuiyangChina
| | - Haijie Jin
- Department of Thoracic OncologyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
- Department of Thoracic OncologyAffiliated Cancer Hospital of Guizhou Medical UniversityGuiyangChina
- Teaching and Research Department of OncologyClinical Medical College of Guizhou Medical UniversityGuiyangChina
| | - Huiqin Li
- Department of Thoracic OncologyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
- Department of Thoracic OncologyAffiliated Cancer Hospital of Guizhou Medical UniversityGuiyangChina
| | - Bing Lu
- Department of Thoracic OncologyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
- Department of Thoracic OncologyAffiliated Cancer Hospital of Guizhou Medical UniversityGuiyangChina
- Teaching and Research Department of OncologyClinical Medical College of Guizhou Medical UniversityGuiyangChina
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Li Q, Hu C, Su S, Ma Z, Geng Y, Hu Y, Li H, Lu B. Failure pattern and radiotherapy exploration in malignant pleural effusion non-small cell lung cancer treated with targeted therapy. Front Oncol 2023; 13:974735. [PMID: 37274290 PMCID: PMC10235634 DOI: 10.3389/fonc.2023.974735] [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: 06/21/2022] [Accepted: 04/20/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose Actionable mutations are common in non-small cell lung cancer(NSCLC)with malignant pleural effusion(MPE)(MPE-NSCLC). The pattern of failure in MPE-NSCLC treated with targeted therapy after MPE control remains unclear. We aimed to investigate the failure pattern of such patients in a cohort study and explore the possibility of radiotherapy. Patients and methods Computed tomography scans of 86 patients were reviewed in this study. We classified first pattern of failure after MPE control as initial disease sites only (IF), new distant sites only (NF), or IF and NF detected simultaneously (INF). Patients evaluated suitable for radiotherapy after disease progression were divided into two groups: D group without radiotherapy and RD group with radiotherapy. The Kaplan-Meier method and log-rank test were used for survival analyses. Results Disease progression after MPE control was observed in 42 patients with complete serial imaging. Median time to any progression was 9.5 months. Rate of the IF, NF and INF were 50%, 17% and 33% for all patients,60%,0% and 40% for patients with MPE recurrence (n=10,23.8%) and 47%, 22% and 31% for patients (n=32,76.2%) without MPE recurrence, respectively. Out of 10 patients(23.8%) with MPE recurrence, 7 patients simultaneous underwent primary tumor progression and 5 MPE were cytologically confirmed in 7 patients with examination. The overall survival (OS )rates at 1, 2, 3 years for the RD group and D group were 88.2%, 50.5%, 21.7% and 80.0%, 20.3%, 0%, respectively; the corresponding MST were 26.1 months and 17.5 months, respectively (χ2 = 4.959, p =0.026). Conclusions Our data indicates that 50% of patients with actionable mutations MPE- NSCLC after MPE control are likely to fail at their initial sites of disease and the use of radiotherapy may bring OS benefits during the course of their disease. Multicenter RCT is necessary to confirm the result in the future.
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Affiliation(s)
- Qingsong Li
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Cheng Hu
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Shengfa Su
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Zhu Ma
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Yichao Geng
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Yinxiang Hu
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Huiqin Li
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Bing Lu
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, China
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Li Q, Hu C, Su S, Ma Z, Geng Y, Hu Y, Li H, Lu B. Non-Small Cell Lung Cancer with Malignant Pleural Effusion May Require Primary Tumor Radiotherapy in Addition to Drug Treatment. Cancer Manag Res 2022; 14:3347-3358. [PMID: 36465711 PMCID: PMC9716933 DOI: 10.2147/cmar.s385818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/15/2022] [Indexed: 09/01/2023] Open
Abstract
PURPOSE The impact of primary tumour radiotherapy on the prognosis for non-small-cell lung cancer (NSCLC) with controlled malignant pleural effusion (MPE-C) (MPE-C-NSCLC) is unclear. This study aimed to analyze the efficacy and safety of primary tumor radiotherapy in patients with MPE-C-NSCLC. PATIENTS AND METHODS A total of 186 patients with MPE-C-NSCLC were enrolled and divided into two groups. The patients in the D group were treated with only drugs. Those in the RD group were treated with drugs plus primary tumour radiotherapy. The Kaplan-Meier method was used for survival analysis, and the Log rank test was used for between-group analysis and univariate prognostic analysis. The Cox proportional hazards model was used to perform multivariate analyses to assess the impacts of factors on survival. Propensity score matching (PSM) was matched based on clinical characteristics, systematic drug treatment and drug response to further adjust for confounding factors. RESULTS The overall survival (OS) rates at 1, 2, and 3 years for the RD group and D group were 54.4%, 26.8%, and 13.3% and 31.1%, 11.5%, and 4.4%, respectively; the corresponding MSTs were 14 months and 8 months, respectively (χ 2=15.915, p<0.001). There was a significant difference in survival by PSM (p=0.027).Before PSM, multivariate analysis showed that metastasis status (organ≤3 and metastasis≤5), primary tumour radiotherapy, chemotherapy cycles≥4, and drug best response (CR+PR) were independent predictors of prolonged OS. After PSM, primary tumour radiotherapy and drug best response (CR+PR) were independent predictors of prolonged OS were still independent predictors of prolonged OS. There were no grade 4-5 radiation toxicities. CONCLUSION For MPE-C-NSCLC, the response of systemic drug treatment plays a crucial role in survival outcomes, and we also should pay attention to primary tumour radiotherapy in addition to systematic drug treatment.
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Affiliation(s)
- Qingsong Li
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Cheng Hu
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Shengfa Su
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Zhu Ma
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Yichao Geng
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Yinxiang Hu
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Huiqin Li
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Bing Lu
- Department of Thoracic Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Department of Thoracic Oncology, Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- Teaching and Research Department of Oncology, Clinical Medical College of Guizhou Medical University, Guiyang, People’s Republic of China
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Wang L, Deng H, Chen X, Li C, Yi F, Wei Y, Zhang W. Talc pleurodesis versus indwelling pleural catheter among patients with malignant pleural effusion: a meta-analysis of randomized controlled trials. World J Surg Oncol 2020; 18:184. [PMID: 32703255 PMCID: PMC7379784 DOI: 10.1186/s12957-020-01940-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Talc pleurodesis (TP) and indwelling pleural catheter (IPC) are used for the management of malignant pleural effusion (MPE). Our meta-analysis was conducted to assess the efficacy and safety of both treatments among patients with MPE. METHODS We acquired pertinent randomized controlled trials (RCTs) by searching PubMed, ScienceDirect, the Cochrane Library, Scopus, Ovid Medline, Embase, Web of Science, and Google Scholar. The endpoints included survival, pleurodesis rates, total drainage, further pleural interventions, hospital days, symptoms, quality of life (QoL), and complications. RESULTS We included four high-quality RCTs. Both treatments were effective among patients with MPE and no previous pleurodesis, with comparable survival and equivalent relief of breathlessness. Additionally, the TP group had higher pleurodesis rates, less total drainage, and fewer all-grade complications (including catheter blockage and cellulitis). However, patients in the TP group had more pleural procedures and relatively longer hospital stays. Additionally, no apparent difference was detected in QoL. CONCLUSIONS TP has better pleurodesis rates, less total drainage, and fewer all-grade complications. However, TP has more pleural procedures and is not feasible for patients with trapped lungs. IPC has fewer further pleural interventions and shorter hospital stays. However, IPC has the nuisance of long-term in situ draining.
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Affiliation(s)
- Li Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Rd, Nanchang, 330006, People's Republic of China
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Huan Deng
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Rd, Nanchang, 330006, People's Republic of China
| | - Xinling Chen
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Can Li
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Fengming Yi
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Rd, Nanchang, 330006, People's Republic of China.
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Rd, Nanchang, 330006, People's Republic of China.
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Rakesh HR, Gelzinis TA. The Updated ATS/STS/STR Clinical Practice Guidelines on the Management of Malignant Pleural Effusions: What Is New in 2018? J Cardiothorac Vasc Anesth 2019; 33:1181-1186. [DOI: 10.1053/j.jvca.2018.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Indexed: 12/16/2022]
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