Malignant pleural effusion and algorithm management

Our plain-English summary of Malignant pleural effusion and algorithm management, by K. Zarogoulidis, P. Zarogoulidis, K. Darwiche, et al (Journal of Thoracic Disease, 2013).

The study

• Authors: K. Zarogoulidis, P. Zarogoulidis, K. Darwiche, K. Tsakiridis, N. Machairiotis, I. Kougioumtzi, N. Courcoutsakis, E. Terzi, B. Zaric, H. Huang, L. Freitag, D. Spyratos
• Journal: Journal of Thoracic Disease
• Published: 2013;5 Suppl 4(Suppl 4):S413-9
• Type of article: Review
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Involvement of the pleura in lung cancer is a common manifestation accompanying with reduced life expectancy. Symptoms relief and improvement of the quality of life are the primary goals of the management of malignant pleural effusion (MPE). Histological confirmation is essential for optimal patient management. Lung cancer patients, with life expectancy more than 3 months, resistant to chemotherapy should be treated with thoracentesis, intercoastal tube drainage and installation of a sclerosant agent or pleurodesis through thoracospopic procedures or placement of an indwelling pleura catheter. Talc pleurodesis (sterile asbestos-free graded, particle size >15 μm), as "poudrage" or "slurry" still remains the treatment of choice in patients with MPE resistant to chemotherapy.

In plain English

This article was a review of how malignant pleural effusion (fluid build-up around the lung caused by cancer) is diagnosed and treated, mainly in lung cancer. It did not study asbestos exposure. Asbestos appeared only in the authors' description of the talc used for treatment: sterile, asbestos-free, graded talc with particles larger than 15 micrometres. Drawing on earlier studies, the review stated that about 10% of malignant pleural effusions come from cancers arising in the pleura itself, and that malignant mesothelioma makes up more than 90% of those. It reported that more than 98% of effusions linked to lung cancer return within 30 days of the first needle drainage. It also reported that a Cochrane review had found talc superior to other agents for controlling the fluid. Most studies comparing two ways of giving talc, sprayed in during thoracoscopy ("poudrage") or as a liquid suspension ("slurry"), showed a slight advantage for poudrage, but this was not statistically significant. The authors concluded that talc pleurodesis remains the treatment of choice for patients whose effusion does not respond to chemotherapy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review article with a proposed management algorithm; no original patient data
• Who was studied: No study population; the review discusses published literature on patients with malignant pleural effusion, mainly from lung cancer
• Exposure: No asbestos exposure was studied. The topic was treatments for malignant pleural effusion. Asbestos is mentioned only in specifying that the talc used is asbestos-free.
• Main results:
  • Citing the literature, the review stated that about 10% of all malignant pleural effusions are due to primary cancers of the pleura, with malignant mesothelioma the predominant type (more than 90%)
  • The review stated that bronchogenic carcinomas and breast cancers are the most common tumors spreading to the pleura (40% and 25% respectively)
  • The review stated that more than 98% of malignant pleural effusions associated with lung cancer relapse within 30 days of the first thoracentesis
  • The review cited a Cochrane review reporting that talc pleurodesis is superior to other sclerosing agents or chest drainage alone
  • The review stated that most comparative studies show a slight advantage of talc poudrage over talc slurry, without statistical significance
  • The review stated that successful pleurodesis occurs in about 75% of patients in large clinical studies
• The authors' conclusion: The authors concluded that talc pleurodesis using sterile, asbestos-free, graded talc remains the treatment of choice for patients with malignant pleural effusion resistant to chemotherapy

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Pleura, Lung Cancer, Life Expectancy, Quality of Life, Chemotherapy, Thoracentesis, Pleurodesis.

Related studies

• Preoperative evaluation for lung cancer resection — D. Spyratos, P. Zarogoulidis, et al. (2014)
• Intrapleural cisplatin and cytarabine in the management of malignant pleural effusions: a Lung Cancer Study Group trial — V.W. Rusch, R. Figlin, et al. (1991)
• The long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions — O. Genc, M. Petrou, et al. (2000)
• Tetracycline sclerosis in the management of malignant pericardial effusion — F.A. Shepherd, J.S. Ginsberg, et al. (1985)
• Current controversies in the management of malignant pleural effusions — M. Azzopardi, J.M. Porcel, et al. (2014)
• Surgical and non-surgical management of malignant pleural effusions — D.B. Fitzgerald, C.F.N. Koegelenberg, et al. (2018)

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