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Malignant Pleural Effusions (malignant + pleural_effusion)

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Medical Sciences100%

Selected Abstracts

Thoracoscopic talc pleurodesis for malignant pleural effusion

ANZ JOURNAL OF SURGERY, Issue 1-2 2003
David Love
Background: Malignant pleural effusion (MPE) is a common and distressing condition at the end of life for many patients with disseminated cancer. The challenge for the surgeon lies in managing this problem in order to deliver the most effective palliation with the least impact on the limited time available to these patients. Methods: Herein is reported a retrospective review of outcomes for a consecutive series of 66 MPE (61 patients) treated over a 5-year period from 1995 to 2000. A standard operative technique involving a single-lung anaesthetic and two-port thoracoscopy was employed. Outcomes were determined by contacting the referring practitioner or the patients themselves. Principal outcome measures included time to recurrence of the effusion and survival. Results: Complete follow up was achieved for 60 MPE (55 patients; five of whom were treated for metachronous, bilateral ­disease). The three most common primary sites were breast, lung and mesothelial tissue. The planned procedure was not completed in two cases due to encasement of the underlying lung by tumour. Primary failure (immediate recurrence of the effusion) occurred in six cases. Delayed recurrence of the effusion occurred in a further 23 MPE resulting in complete control in 31 cases (52%) until death. Overall median survival was 220 days and the 30-day mortality was 0. Conclusions: Complete and permanent control of a malignant effusion is difficult to achieve. Management based on thoracoscopy and talc insufflation produces satisfactory results with an acceptable morbidity and no early mortality. The ability to inspect the pleural space, break down adhesions and completely drain pockets of fluid to achieve complete lung expansion probably contributes to this. [source]

Intracavitary cisplatin therapy for pediatric malignancies,

PEDIATRIC BLOOD & CANCER, Issue 3 2010
Howard M. Katzenstein MD
Abstract Background Local control is essential for the successful treatment of pediatric solid tumors. Complete excision is often not possible and local control therapies are limited. Intracavitary cisplatin (IC-CDDP) may be utilized to supplement local control. The aim of the study was to determine the toxicity and efficacy of locally instilled intracavitary cisplatin in patients with recurrent tumors in closed body cavities. Procedure From 2001 to 2009, 12 patients (1,20 years) with recurrent or unresectable malignant tumors were treated with IC-CDDP. Nine had pulmonary lesions. Three patients had abdominal tumors. CDDP (200,mg/m2) was instilled by chest tube or Tenckhoff catheter. Patients were shifted every 15,30,min to allow distribution. After 4,hr, residual was drained by gravity. In 10/13 courses, sodium thiosulfate (STS) was administered to prevent nephrotoxicity. Three other patients received amifostine. Results Malignant pleural effusions resolved in 5/7 patients. This response was temporary in three patients. No patients had ascites prior to treatment. Three patients are alive and disease-free, 18 months, 4 years, and 6 years from treatment. They also had surgery and chemotherapy. Transient renal toxicity was noted in most patients. One patient, treated with amifostine, had persistent renal dysfunction. Conclusions IC-CDDP was effective in treating malignant pleural effusions and may be a palliative option for refractory disease. Long-term survival was achieved in two patients, treated at first diagnosis. The benefit of IC-CDDP in these patients is difficult to assess. Renal dysfunction is usually mild, and typically resolves, but warrants preventive measures with IC-CDDP therapy. Pediatr Blood Cancer. 2010;55:452,456. © 2010 Wiley-Liss, Inc. [source]

A comparative study of pleurodesis using talc slurry and bleomycin in the management of malignant pleural effusions

RESPIROLOGY, Issue 2 2000
Kian Chung Ong
Objective: Differing success rates of various pleurodesis agents have been reported in the management of malignant pleural effusions. A randomized clinical trial was conducted to compare the efficacy of two commonly used agents, talc and bleomycin, for the pleurodesis of malignant pleural effusions. Methodology: Inclusion in the study required proof of a malignant pleural effusion by fluid cytology or pleural biopsy. Exclusion criteria included trapped lung, loculated effusions, recurrent effusions and life expectancy < 1 month. Five grams of talc or 1 unit per kilogram bodyweight of bleomycin mixed in 150 mL of normal saline was administered via tube thoracostomy after complete drainage of the pleural effusion in each patient. Treatment success was defined as the absence of recurrent pleural effusion on the chest radiograph 1 month after pleurodesis. Results: Treatment success was achieved in 16 out of 18 patients (89%) in the talc slurry group versus 14 out of 20 patients (70%) in the bleomycin group (P = 0.168). Fever and pain were the only side-effects of pleurodesis in both groups. Conclusion: These results indicate that talc slurry is as effective as bleomycin in preventing early recurrence of malignant pleural effusions. Pleurodesis with talc instead of bleomycin can result in significant cost savings. [source]

Thoracoscopic talc pleurodesis for malignant pleural effusion

ANZ JOURNAL OF SURGERY, Issue 1-2 2003
David Love
Background: Malignant pleural effusion (MPE) is a common and distressing condition at the end of life for many patients with disseminated cancer. The challenge for the surgeon lies in managing this problem in order to deliver the most effective palliation with the least impact on the limited time available to these patients. Methods: Herein is reported a retrospective review of outcomes for a consecutive series of 66 MPE (61 patients) treated over a 5-year period from 1995 to 2000. A standard operative technique involving a single-lung anaesthetic and two-port thoracoscopy was employed. Outcomes were determined by contacting the referring practitioner or the patients themselves. Principal outcome measures included time to recurrence of the effusion and survival. Results: Complete follow up was achieved for 60 MPE (55 patients; five of whom were treated for metachronous, bilateral ­disease). The three most common primary sites were breast, lung and mesothelial tissue. The planned procedure was not completed in two cases due to encasement of the underlying lung by tumour. Primary failure (immediate recurrence of the effusion) occurred in six cases. Delayed recurrence of the effusion occurred in a further 23 MPE resulting in complete control in 31 cases (52%) until death. Overall median survival was 220 days and the 30-day mortality was 0. Conclusions: Complete and permanent control of a malignant effusion is difficult to achieve. Management based on thoracoscopy and talc insufflation produces satisfactory results with an acceptable morbidity and no early mortality. The ability to inspect the pleural space, break down adhesions and completely drain pockets of fluid to achieve complete lung expansion probably contributes to this. [source]

Intracavitary cisplatin therapy for pediatric malignancies,

PEDIATRIC BLOOD & CANCER, Issue 3 2010
Howard M. Katzenstein MD
Abstract Background Local control is essential for the successful treatment of pediatric solid tumors. Complete excision is often not possible and local control therapies are limited. Intracavitary cisplatin (IC-CDDP) may be utilized to supplement local control. The aim of the study was to determine the toxicity and efficacy of locally instilled intracavitary cisplatin in patients with recurrent tumors in closed body cavities. Procedure From 2001 to 2009, 12 patients (1,20 years) with recurrent or unresectable malignant tumors were treated with IC-CDDP. Nine had pulmonary lesions. Three patients had abdominal tumors. CDDP (200,mg/m2) was instilled by chest tube or Tenckhoff catheter. Patients were shifted every 15,30,min to allow distribution. After 4,hr, residual was drained by gravity. In 10/13 courses, sodium thiosulfate (STS) was administered to prevent nephrotoxicity. Three other patients received amifostine. Results Malignant pleural effusions resolved in 5/7 patients. This response was temporary in three patients. No patients had ascites prior to treatment. Three patients are alive and disease-free, 18 months, 4 years, and 6 years from treatment. They also had surgery and chemotherapy. Transient renal toxicity was noted in most patients. One patient, treated with amifostine, had persistent renal dysfunction. Conclusions IC-CDDP was effective in treating malignant pleural effusions and may be a palliative option for refractory disease. Long-term survival was achieved in two patients, treated at first diagnosis. The benefit of IC-CDDP in these patients is difficult to assess. Renal dysfunction is usually mild, and typically resolves, but warrants preventive measures with IC-CDDP therapy. Pediatr Blood Cancer. 2010;55:452,456. © 2010 Wiley-Liss, Inc. [source]

Osteopontin is upregulated in malignant and inflammatory pleural effusions

RESPIROLOGY, Issue 5 2009
Charalampos MOSCHOS
ABSTRACT Background and objective: Osteopontin (OPN) is an important mediator of inflammation and cancer progression. In the present study, we asked whether pleural fluid (PF) and serum OPN concentrations differed between patients with pleural effusions of different aetiologies, and whether assessment of OPN levels was useful for diagnostic purposes. Methods: One hundred and nine consecutive patients with pleural effusions of different aetiologies were recruited prospectively during daily clinics. OPN levels were measured by ELISA. Results: PF OPN levels were 10-fold higher in exudates than in transudates and were significantly correlated with markers of pleural inflammation and vascular hyper-permeability, such as PF/serum LDH or protein ratios, PF protein and PF vascular endothelial growth factor levels. Patients with malignant pleural effusions had higher PF and lower serum OPN concentrations than those with benign disease. The diagnostic accuracies of PF and PF/serum OPN for malignancy were 71.5% (95% CI: 64,80) and 70.6% (95% CI: 62,80), respectively. Conclusions: OPN levels were elevated in exudative pleural effusions, as compared with the levels in blood or transudative pleural effusions. While PF and PF/serum OPN were higher in patients with malignancies, the diagnostic accuracy of the tests was not sufficient to permit routine use in clinical practice. [source]

Prospective evaluation of flex-rigid pleuroscopy for indeterminate pleural effusion: Accuracy, safety and outcome

RESPIROLOGY, Issue 6 2007
Pyng LEE
Objective: This study aimed to assess prospectively the accuracy, safety and outcome of flex-rigid pleuroscopy in the diagnosis of patients with indeterminate pleural effusions. Methods: Included in the study were all patients with unilateral exudative pleural effusions of unknown aetiology who underwent diagnostic flex-rigid pleuroscopy from July 2003 to June 2005, and were followed until December 2005. The procedure was conducted in the endoscopy suite under local anaesthesia and, where indicated, talc poudrage was carried out at the same time. Clinical data, length of hospitalization, chest tube drainage, outcome, diagnostic accuracy of pleuroscopy and procedure-related adverse events were recorded prospectively. Results: Fifty-one patients were recruited (20 male and 31 female). Median age was 53 years (range 45,67). Flex-rigid pleuroscopy was 96% accurate and yielded a diagnosis in 49 out of 51 patients. It was safely carried out without need for surgical intervention, blood transfusion or endotracheal intubation. Culture-negative fever was observed in eight patients (16%), and five patients (10%) required additional analgesia for postoperative pain. Duration of chest tube drainage and length of stay for patients who underwent diagnostic pleuroscopy were 1 and 2 days, respectively, while they were both 3 days when talc poudrage was carried out. Success rates with pleuroscopic talc pleurodesis for malignant pleural effusions were 94%, 92% and 89.5% at 3, 6 and 12 months, respectively, and the 30-day mortality was 0%. Conclusion: Flex-rigid pleuroscopy is a safe procedure with a high diagnostic accuracy and should be considered for the evaluation of indeterminate pleural effusion. [source]

A comparative study of pleurodesis using talc slurry and bleomycin in the management of malignant pleural effusions

RESPIROLOGY, Issue 2 2000
Kian Chung Ong
Objective: Differing success rates of various pleurodesis agents have been reported in the management of malignant pleural effusions. A randomized clinical trial was conducted to compare the efficacy of two commonly used agents, talc and bleomycin, for the pleurodesis of malignant pleural effusions. Methodology: Inclusion in the study required proof of a malignant pleural effusion by fluid cytology or pleural biopsy. Exclusion criteria included trapped lung, loculated effusions, recurrent effusions and life expectancy < 1 month. Five grams of talc or 1 unit per kilogram bodyweight of bleomycin mixed in 150 mL of normal saline was administered via tube thoracostomy after complete drainage of the pleural effusion in each patient. Treatment success was defined as the absence of recurrent pleural effusion on the chest radiograph 1 month after pleurodesis. Results: Treatment success was achieved in 16 out of 18 patients (89%) in the talc slurry group versus 14 out of 20 patients (70%) in the bleomycin group (P = 0.168). Fever and pain were the only side-effects of pleurodesis in both groups. Conclusion: These results indicate that talc slurry is as effective as bleomycin in preventing early recurrence of malignant pleural effusions. Pleurodesis with talc instead of bleomycin can result in significant cost savings. [source]

Molecular mechanisms of angiogenesis in non-small cell lung cancer, and therapeutics targeting related molecules

CANCER SCIENCE, Issue 6 2003
Seiji Yano
Angiogenesis, neovascularization from pre-existing vasculature, is necessary to supply oxygen and nutrition for tumor growth in both primary and distant organs. It consists of sprouting and non-sprouting (the enlargement, splitting, and fusion of pre-existing vessels) processes, and both can occur concurrently. Growth of solid tumors, including non-small cell lung cancer (NSCLC), is usually dependent on angiogenesis, which is regulated by complex mechanisms involving various angiogenesis-related molecules. Vascular endothelial growth factor (VEGF), also known as vascular permeability factor (VPF), one of the most potent angiogenic molecules, regulates both angiogenesis and vascular permeability, and hence promotes tumor progression and development of malignant pleural effusions in NSCLC. Signals via epidermal growth factor receptor (EGFR) promote not only the tumor cell cycle, but also the process of angiogenesis. Therefore, these molecules are potential targets for anti-tumor vasculature therapy. Many agents targeting tumor vasculature have been developed, and several compounds have shown anti-tumor potential in pre-clinical studies. Their efficacy against NSCLC is currently being evaluated in clinical trials. [source]