Management of Pleural Effusion Secondary to Malignant Mesothelioma

Our plain-English summary of Management of Pleural Effusion Secondary to Malignant Mesothelioma, by V. Musso, C. Diotti, A. Palleschi, et al (Journal of Clinical Medicine, 2021).

The study

• Authors: V. Musso, C. Diotti, A. Palleschi, D. Tosi, A. Aiolfi, P. Mendogni
• Journal: Journal of Clinical Medicine
• Published: 2021;10(18)
• Type of article: Review
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a highly aggressive pleural tumour which has been epidemiologically linked to occupational exposure to asbestos. MPM is often associated with pleural effusion, which is a common cause of morbidity and whose management remains a clinical challenge. In this review, we analysed the literature regarding the diagnosis and therapeutic options of pleural effusion secondary to mesothelioma. Our aim was to provide a comprehensive view on this subject, and a new algorithm was proposed as a practical aid to clinicians dealing with patients suffering from pleural effusion.

In plain English

This article was a narrative review, not a new study of patients. The authors searched PubMed for articles on mesothelioma and malignant pleural effusion (fluid build-up around the lung). They excluded non-English articles and case reports, and did not report how many articles they found or included. The review described malignant pleural mesothelioma as an aggressive tumour that has been epidemiologically linked to occupational asbestos exposure. It noted that effusion occurs in 54 to 90% of these patients. It summarised imaging, fluid testing and biopsy, noting that fluid cytology has poor sensitivity and that an expert group strongly suggests a tissue sample for diagnosis. For treatment, it reviewed talc pleurodesis (sealing the pleural space), indwelling pleural catheters, partial pleurectomy and drug therapy given into the chest. It cited a retrospective analysis of 390 patients reporting that pleurodesis worked in only about 30% of treated mesothelioma patients, whether done surgically or at the bedside. The authors proposed a management algorithm and concluded that treatment should be tailored to each patient, considering quality of life and time in hospital. They did not state limitations of their review.

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 literature review with a proposed diagnostic and treatment algorithm
• Who was studied: Published literature found through PubMed on the diagnosis and treatment of pleural effusion secondary to malignant pleural mesothelioma. Only English-language articles were used and case reports were excluded. The number of articles and the search dates were not reported.
• Exposure: Not studied directly. The review notes that malignant pleural mesothelioma has been epidemiologically linked to occupational asbestos exposure, without naming fiber types.
• Main results:
  • The review reported that pleural effusion occurs in 54 to 90% of patients with malignant pleural mesothelioma (citing another source).
  • The review stated that analysis of pleural fluid has poor sensitivity for diagnosing mesothelioma: around 30%, and as low as 16% in some studies.
  • The review noted that the International Mesothelioma Interest Group strongly suggests a histological (tissue) sample for the definitive diagnosis.
  • Citing a guideline, the review described talc pleurodesis as the standard treatment for recurrent effusion when life expectancy is more than 3 months.
  • The review cited a retrospective analysis of 390 mesothelioma patients by Fysh et al. comparing surgical and bedside chemical pleurodesis. In both treatment groups, pleurodesis was effective in only about 30% of the treated patients.
  • The review cited a prospective cohort by Bibby et al. of 192 mesothelioma patients with pleural effusion. That study described 64 cases (33.3%) of non-expandable lung, which was associated with shorter survival (hazard ratio for mortality 1.80).
  • The review described indwelling pleural catheters as indicated when pleurodesis has failed or the lung cannot expand. It cited a retrospective review that reported catheter tract metastasis in 11 of 107 catheter patients (10%), mainly in mesothelioma, and a systematic review that reported 0.8%.
• The authors' conclusion: The authors concluded that recurrent pleural effusion in mesothelioma remains a clinical challenge. They said the best treatment should be tailored to the patient, considering quality of life and time in hospital. They offered their diagnostic and treatment approach as a practical tool for clinicians and called for further research.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Malignant Mesothelioma, Pleural Mesothelioma, Occupational Exposure, Mesothelioma.

Related studies

• Cytogenetic findings in an effusion secondary from pleural mesothelioma — M.J. Bello, J.A. Rey, et al. (1987)
• 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)
• Malignant pleural effusion and algorithm management — K. Zarogoulidis, P. Zarogoulidis, et al. (2013)
• Current controversies in the management of malignant pleural effusions — M. Azzopardi, J.M. Porcel, et al. (2014)

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