Comparing approaches to the management of malignant pleural effusions

José M. Porcel, Macy Mei Sze Lui, Andrew D. Lerner, Helen E. Davies, David Feller-Kopman, Y. C.Gary Lee

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: Management of symptomatic malignant pleural effusions is becoming more complex due to the range of treatment options, which include therapeutic thoracenteses, thoracoscopic talc pleurodesis, bedside pleurodesis with talc or other sclerosing agents via small-bore chest catheters, indwelling pleural catheters, surgery, or a combination of some of these procedures. Areas covered: Recent advances for the expanding range of treatment options in malignant pleural effusions are summarized, according to the best available evidence. Expert commentary: Selection of a treatment approach in malignant pleural effusions should take into account patient preferences and performance status, tumor type, predicted prognosis, presence of a non-expandable lung, and local experience or availability. The role of pleurodesis has decreased with the advent of indwelling pleural catheters, which provide a high degree of symptomatic relief on an outpatient basis and, therefore, are being positioned as a first choice therapy in many centers. Talc poudrage pleurodesis should probably be reserved for those situations in which pleural tumor invasion is discovered during diagnostic thoracoscopy. Ongoing randomized controlled trials will offer solid evidence on which of the available palliative approaches should be selected for each particular patient.

Original languageEnglish (US)
Pages (from-to)273-284
Number of pages12
JournalExpert review of respiratory medicine
Volume11
Issue number4
DOIs
StatePublished - Apr 3 2017

Keywords

  • Malignant pleural effusion
  • indwelling pleural catheter
  • pleurodesis
  • talc
  • thoracentesis
  • thoracoscopy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine
  • Public Health, Environmental and Occupational Health

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