Skip to main content
SpringerLink
Log in

Management of malignant pleural effusions

  • Review
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Malignant pleural effusions are a common clinical problem in patients with primary thoracic malignancy and metastatic malignancy to the thorax. Symptoms can be debilitating and can impair tolerance of anticancer therapy. This article presents a comprehensive review of pharmaceutical and nonpharmaceutical approaches to the management of malignant pleural effusion, and a novel algorithm for management based on patients’ performance status.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Marel M, Zrustova M, Stasny B, et al. The incidence of pleural effusion in a well-defined region. Epidemiologic study in central Bohemia. Chest. 1993;104:1486–1489.

    Article  PubMed  CAS  Google Scholar 

  2. Antony VB, Loddenkemper R, Astoul P, et al. Management of malignant pleural effusions. Am J Respir Crit Care Med. 2000;162:1987–2001.

    Google Scholar 

  3. Putnam JB Jr, Walsh GL, Swisher SG, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg. 2000;69:369–375.

    Article  PubMed  Google Scholar 

  4. Rodriguez-Panadero F, Janssen JP, Astoul P. Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur Respir J. 2006;28:409–422.

    Article  PubMed  CAS  Google Scholar 

  5. Shannon VR, Eapen GA, Jimenez CA, et al. Respiratory complications. In: Kufe DW, Blast Jr RC, Hait WN, et al., eds. Cancer Medicine 7. 7th edition. Philadelphia, PA, USA: BC Decker Inc; 2006:2150–2173.

    Google Scholar 

  6. Sahn SA. Malignancy metastatic to the pleura. Clin Chest Med. 1998;19:351–361.

    Article  PubMed  CAS  Google Scholar 

  7. Sahn SA. Pleural diseases related to metastatic malignancies. Eur Respir J. 1997;10:1907–1901.

    Article  PubMed  CAS  Google Scholar 

  8. Meyer PC. Metastatic carcinoma of the pleura. Thorax. 1966;21;437–443.

    Article  PubMed  CAS  Google Scholar 

  9. Light RW, Hamm H. Malignant pleural effusion: would the real cause please stand up? Eur Respir J. 1997;10:1701–1702.

    Article  PubMed  CAS  Google Scholar 

  10. Chernow B, Sahn SA. Carcinomatous involvement of the pleura: an analysis of 96 patients. Am J Med. 1977;63:695–702.

    Article  PubMed  CAS  Google Scholar 

  11. Zebrowski BK, Yano S, Liu W, et al. Vascular endothelial growth factor levels and induction of permeability in malignant pleural effusions. Clin Cancer Res. 1999;5:3364–3368.

    PubMed  CAS  Google Scholar 

  12. Yeh HH, Lai WW, Chen HH, et al. Autocrine IL-6-induced Stat3 activation contributes to the pathogenesis of lung adenocarcinoma and malignant pleural effusion Oncogene. 2006;25:4300–4309.

    Article  PubMed  CAS  Google Scholar 

  13. Heffner JE, Klein JS, Hampson C. Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 2010;137:467–479.

    Article  PubMed  Google Scholar 

  14. Porcel JM, Alvarez M, Salud A, Vives M. Should a cytologic study be ordered in transudative pleural effusions? Chest. 1999;116:1836–1837.

    Article  PubMed  CAS  Google Scholar 

  15. Ashchi M, Golish J, Eng P, O’Donovan P. Transudative malignant pleural effusions: prevalence and mechanisms. South Med J. 1998;91:23–26

    PubMed  CAS  Google Scholar 

  16. Abouzgheib W, Bartter T, Dagher H, Pratter M, Klump W. A prospective study of the volume of pleural fluid required for accurate diagnosis of malignant pleural effusion. Chest. 2009;135:999–1001.

    Article  PubMed  Google Scholar 

  17. Swiderek J, Morcos S, Donthireddy V, et al. Prospective study to determine the volume of pleural fluid required to diagnose malignancy. Chest. 2010;137:68–73.

    Article  PubMed  Google Scholar 

  18. Davies HE, Sadler RS, Bielsa S, et al. Clinical impact and reliability of pleural fluid mesothelin in undiagnosed pleural effusions. Am J Respir Crit Care Med. 2009;180:437–444.

    Article  PubMed  Google Scholar 

  19. Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med. 1991;114:271–277.

    PubMed  CAS  Google Scholar 

  20. Ferrer J, Roldán J, Teixidor J, Pallisa E, Gich I, Morell F. Predictors of pleural malignancy in patients with pleural effusion undergoing thoracoscopy. Chest. 2005;127:1017–1022.

    Article  PubMed  Google Scholar 

  21. Bielsa S, Martin-Juan J, Porcel JM, Rodriguez-Panadero F. Diagnostic and prognostic implications of pleural adhesions in malignant effusions. J Thorac Oncol. 2008;3:1251–1256.

    Article  PubMed  Google Scholar 

  22. Jones PW, Moyers JP, Rogers JT Ultrasound-guided thoracentesis: is it a safer method? Chest. 2003;123:418–423.

    Article  PubMed  Google Scholar 

  23. Feller-Kopman D, Berkowitz D, Boiselle P, Ernst A. Large-volume thoracentesis and the risk of reexpansion pulmonary edema. Ann Thorac Surg. 2007;84:1656–1661.

    Article  PubMed  Google Scholar 

  24. Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med. 2010;170:332–339.

    Article  PubMed  Google Scholar 

  25. Neragi-Miandoab S. Malignant pleural effusion, current and evolving approaches for its diagnosis and management. Lung Cancer. 2006;54:1–9.

    Article  PubMed  Google Scholar 

  26. Musani A, Haas A, Seijo L, Wilby M, Sterman D. Outpatient management of malignant pleural effusions with small-bore, tunneled pleural catheters. Respiration. 2004;71:559–566.

    Article  PubMed  Google Scholar 

  27. Putnam JB, Walsh GL, Swisher SG, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg. 2000;69:369–375.

    Article  PubMed  Google Scholar 

  28. Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest. 2006;129:362–368.

    Article  PubMed  Google Scholar 

  29. Warren WH, Kalimi R, Khodadadian LM, Kim AW. Management of malignant pleural effusions using the Pleur(x) catheter. Ann Thorac Surg. 2008;85:1049–1055.

    Article  PubMed  Google Scholar 

  30. Tremblay A, Mason C, Michaud G. Use of tunnelled catheters for malignant pleural effusions in patients fit for pleurodesis. Eur Respir J. 2007;30:759–762.

    Article  PubMed  CAS  Google Scholar 

  31. Jimenez CA, Ozcakar B, Morice RC, et al. Pleurodesis after intrapleural catheter insertion is an independent factor for overall survival in patients with malignant pleural effusions. Eur Respir J. 2009;34(Suppl. 53):299.

    Google Scholar 

  32. Sterman DH, Recio A, Carroll RG, et al. A phase I clinical trial of single-dose intrapleural IFN-beta gene transfer for malignant pleural mesothelioma and metastatic pleural effusions: high rate of antitumor immune responses. Clin Cancer Res. 2007;13:4456–4466.

    Article  PubMed  CAS  Google Scholar 

  33. Pien GW, Gant MJ, Washam CL, Sterman DH. Use of an implantable pleural catheter for trapped lung syndrome in patients with malignant pleural effusion. Chest. 2001;119:1641–1646.

    Article  PubMed  CAS  Google Scholar 

  34. Jimenez CA, Mhatre AD, Martinez CH, Eapen GA, Onn A, Morice RC. Management of recurrent chylothorax in patients with cancer. Chest. 2007;132:1584–1590.

    Article  PubMed  Google Scholar 

  35. Sartori S, Tombesi P, Tassinari D, et al. Sonographically guided small-bore chest tubes and sonographic monitoring for rapid sclerotherapy of recurrent malignant pleural effusions. J Ultrasound Med. 2004;23:1171–1176.

    PubMed  Google Scholar 

  36. Spiegler PA, Hurewitz AN, Groth ML. Rapid pleurodesis for malignant pleural effusions. Chest. 2003;123:1895–1898.

    Article  PubMed  Google Scholar 

  37. Tan C, Sedrakyan A, Browne J, et al. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardio-Thorac Surg. 2006;29:829–838.

    Article  Google Scholar 

  38. Casal RF, Eapen GA, Morice RC, Jimenez CA. Medical thoracoscopy. Curr Opin Pulm Med. 2009;15:313–320.

    Article  PubMed  Google Scholar 

  39. Viskum K, Enk B. Complications of thoracoscopy. Poumon Coeur. 1981;37:25–28.

    PubMed  CAS  Google Scholar 

  40. Wilson WC, Benumof JL. Anesthesia for thoracic surgery. In: Miller RD, Eriksson LI et al., eds. Miller’s Anesthesia. 7th edition. Morristown, NJ, USA: Churchill Livingstone; 2009:chapter 49.

    Google Scholar 

  41. Hill SE, Keller RA, Stafford-Smith M, et al. Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures. Anesthesiology. 2006;104:1047–1053.

    Article  PubMed  CAS  Google Scholar 

  42. Pompeo E. Awake operative videothoracoscopic pulmonary resections. Thorac Surg Clin. 2008;18:311–320.

    Article  PubMed  Google Scholar 

  43. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev. 2004;(1):CD002916.

  44. Yim AP, Chan AT, Lee TW, Wan IY, Ho JK. Thoracoscopic talc insufflation versus talc slurry for symptomatic malignant pleural effusion. Ann Thorac Surg. 1996;62:1655–1658.

    Article  PubMed  CAS  Google Scholar 

  45. Manes N, Rodriguez-Panadero F, Bravo JL, Hernandez H, Alix A. Talc pleurodesis. Prospective and randomised study. Clinical follow-up. Chest. 2000;118:131.

    Google Scholar 

  46. Dresler CM, Olak J, Herndon JE 2nd, et al. Phase III intergroup study of talc poudrage vs. talc slurry sclerosis for malignant pleural effusion. Chest. 2005;127:909–915.

    Article  PubMed  Google Scholar 

  47. Campos JR, Werebe EC, Vargas FS, Jatene FB, Light RW. Respiratory failure due to insufflated talc. Lancet. 1997;349:251–252.

    Article  PubMed  CAS  Google Scholar 

  48. Rehse DH, Aye RW, Florence MG. Respiratory failure following talc pleurodesis. Am J Surg. 1999;177:437–440.

    Article  PubMed  CAS  Google Scholar 

  49. Maskell NA, Lee YCG, Gleeson FV, et al. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004;170:377–382.

    Article  PubMed  Google Scholar 

  50. Julius PJ, Gareth C, Phillippe A, et al. Safety of pleurodesis with talc poudarage in malignant pleural effusion: a prospective cohort study. Lancet. 2007;369:1535–1539.

    Article  Google Scholar 

  51. Light RW, Cheng D-S, Lee YC, et al. A single intrapleural injection of transforming growth factor-2 produces excellent pleurodesis in rabbits. Am J Respir Crit Care Med. 2000;162:98–104.

    PubMed  CAS  Google Scholar 

  52. Lee YCG, Teixeira LR, Devin CJ, et al. Transforming growth factor-beta(2) induces pleurodesis significantly faster than talc. Am J Respir Crit Care Med. 2001;163:640–644.

    Google Scholar 

  53. Dong M, Li X, Hong LJ, et al. Advanced malignant pleural or peritoneal effusion in patients treated with recombinant adenovirus p53 injection plus cisplatin. J Int Med Res. 2008;36:1273–1278.

    PubMed  CAS  Google Scholar 

  54. Rahman NM, Davies HE, Salzberg M, et al. Use of lipoteichoic acid-T for pleurodesis in malignant pleural effusion: a phase I toxicity and doseescalation study. Lancet Oncol. 2008;9:946–952.

    Article  PubMed  CAS  Google Scholar 

  55. Crnjac A, Sok M, Kamenik M. Impact of pleural effusion pH on the efficacy of thoracoscopic mechanical pleurodesis in patients with breast carcinoma Eur J Cardiothorac Surg. 2004;26:432–436.

    Article  PubMed  CAS  Google Scholar 

  56. Reich H, Beattie EJ, Harvey JC. Pleuroperitoneal shunt for malignant pleural effusions: a one-year experience. Semin Surg Oncol. 1993;9:160–162.

    Article  PubMed  CAS  Google Scholar 

  57. Lee KA, Harvey JC, Reich H, et al. Management of malignant pleural effusions with pleuroperitoneal shunting. J Am Coll Surg. 1994;178:586–588.

    PubMed  CAS  Google Scholar 

  58. Burrows CM, Mathews WC, Colt HG. Predicting survival in patients with recurrent symptomatic malignant pleural effusions: an assessment of the prognostic values of physiologic, morphologic, and quality of life measures of extent of disease. Chest. 2000;117:73–78.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, Texas, USA

    Mateen H. Uzbeck, Francisco A. Almeida, Rodolfo C. Morice, Carlos A. Jimenez & Georgie A. Eapen

  2. Department of Anesthesia, MD Anderson Cancer Center, Houston, Texas, USA

    Mona G. Sarkiss

  3. Cork University Hospital, Wilton, Cork, County Cork, Republic of Ireland

    Marcus P. Kennedy

Authors
  1. Mateen H. Uzbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francisco A. Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mona G. Sarkiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rodolfo C. Morice
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlos A. Jimenez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Georgie A. Eapen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marcus P. Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcus P. Kennedy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uzbeck, M.H., Almeida, F.A., Sarkiss, M.G. et al. Management of malignant pleural effusions. Adv Therapy 27, 334–347 (2010). https://doi.org/10.1007/S12325-010-0031-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/S12325-010-0031-8

Keywords

Search

Navigation