Manage patients with malignant pleural collection

(The text is taken from the doctoral thesis of Dr Athanasios Kleontas)

The incidence of malignant pleural effusion in patients with neoplasia is proportional to the primary focus of the neoplasia. Thus, as clearly shown in a meta-analysis, the most frequent occurrence of malignant pleural effusion is found in lung cancer (37.5%) followed by breast cancer (16.8%), lymphomas (11.5%), urogenital malignancies (9.4%), gastrointestinal malignancies (6. 9%) and others less frequently (85). All histological types of lung cancer are likely to cause pleural effusion, with adenocarcinoma of the lung being the most common (40% of cases) and small cell carcinoma of the lung second most common (25% of cases) (98). The median survival of these patients is about eight months, while the five-year survival is no more than 2% (99).

Figure 9

Algorithm of patients with malignant pleural effusion (97)

Translated from: Fig. 5 Recommendations of diagnosis and treatment of pleural effusion. Update.

Villena Garrido et al

Arch Bronconeumol. 2014 Jun;50(6):235-49.

Figure 10

Algorithm of patients with malignant pleural effusion (85)

Translated from: Fig. 1 Management of a malignant pleural effusion:

British Thoracic Society pleural disease guideline

Mark E. Roberts et al

Thorax 2010;65(Suppl 2):ii32eii40

Figure 11

Algorithm of patients with malignant pleural effusion (97)

Translated from: Fig.6  Malignant pleural effusion and algorithm management

Konstantinos Zarogoulidis et al

J Thorac Dis 2013;5(S4):S413-S419

Compared to patients classified in the same TNM stage but without pleural effusion, both median survival and 5-year survival are worse, statistically significantly (p=0.0001), in patients with pleural effusion (8 months VS 13 months and 2% VS 13%) (100).

The three best-known algorithms for the management and treatment of malignant pleural effusion are presented above, which have much in common, while in some others they complement each other (Figures 9-11) (85,97,101).

Guidelines

• 2018 Management of Malignant Pleural Effusions
• 2017  A review of the management of complex para-pneumonic effusion in adults
• 2016  A benchmarking project on the quality of previous guidelines about the management of malignant pleural effusion from the European Society of Thoracic Surgeons (ESTS) Pleural Diseases Working Group
• 2016  Current practices in the management of malignant pleural effusions: a survey among members of the European Society of Thoracic Surgeons
• 2014  Algorithm for the Management of Malignant Pleural Effusion
• 2010  Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010