Malignant Pleural Effusions
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
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You can arrange an appointment with the doctor
In the morning the Thoracic Surgeon, Dr Athanasios Kleontas MD is at the Interbalkan Medical Center of Thessaloniki, while in the evening he is at his private office (73, Ermou St).
+30 2310 - 400000
Office 11, 2nd floor. Dec 1742
ATHANASIOS D. KLEONTAS
PATIENT VISITATION HOURS
Doctor is available (by mobile) 24 hours a day, 7 days a week.
You meet him only by appointment at his private office:
Monday to Friday : 18.00 - 21.00