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Results for “Pleural Effusion, Malignant”

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At least 19 recordsLinked to original sources

PubMed1997

[The value of erythromycin pleurodesis in the treatment of malignant pleural effusions].

Malignant pleural effusion is a frequent complication of patients with advanced malignant tumors. For many patients suffering from malignant pleural effusion that increases rapidly and may be life threatening, it is important to control the effusions. To investigate the value of erythromycin as a pleural sclerosant, a dose of 1 g erythromycin in 30 ml of 5% glucose was injected into the pleural cavity of 26 patients with malignant pleural effusion. The results were assessed by Miller's standards. After treatment, numerous adhesions were present in 15 cases; Pleural effusion reduced in 7 patients, and no effect was noted in 4 patients. The total response rate was 84.6%, and there were no severe side-effects. The erythromycin-induced pleurodesis is probably the result of induced chemical inflammation in the locality. This study suggests that erythromycin is a useful pleural sclerosant.

Adenocarcinoma↗

PubMed1994

Use of pleural Tenckhoff catheter to palliate malignant pleural effusion.

Malignant pleural effusion and its treatment both cause substantial morbidity in patients with advanced neoplastic disease. We hypothesized that this morbidity might be ameliorated by placement of an indwelling Tenckhoff catheter into the involved pleural space. Catheters were placed in 9 patients under local anesthesia. Three patients underwent bilateral catheter placement, for a total of 12 catheters placed. Four of the 9 patients had undergone previous unsuccessful pleurodesis (using tetracycline or bleomycin). Whenever it became symptomatic, the malignant pleural effusion was simply drained into a calibrated container and the volume recorded. Patients were followed on a weekly basis until their death (mean, 16 weeks). The mean drainage was 477 mL per 24 hours (range, 200 to 1,100 mL). No pleural space infections occurred, although local cellulitis developed in 3 patients around the catheter exit site; all patients responded to oral antibiotics. There were no significant changes in either the serum albumin or total protein levels. No catheters malfunctioned and no patients required further treatment or hospitalization for symptoms of malignant pleural effusion. We conclude that this technique may reduce the morbidity stemming from malignant pleural effusion and its treatment by allowing patients to conveniently and painlessly drain the effusion at home when it becomes symptomatic. This technique may provide superior palliation in patients with malignant pleural effusion.

Adult↗

PubMed2004

[Complications of malignant tumors--malignant pleural effusions].

Malignant pleural effusion is a complication of malignant diseases that has an appreciable negative impact on the patient's quality of life. In view of the greatly reduced life expectancy of between 3 and 12 months (median), diagnostic and therapeutic management must be orientated to the principles of palliation. Diagnostic measures comprise cytological/histological confirmation of the malignant effusion and, where necessary, of the underlying malignant disease and the extent of the intrathoracic tumor growth. In view of the tendency of malignant pleural effusion to relapse, pleurodesis is indicated, which is most effectively accomplished by video-assisted thoracoscopic talcum poudrage.

Biopsy↗

PubMed1996

Thoracoscopic management of malignant pleural effusions.

Malignant pleural effusion is a common condition and often presents a challenge for treatment. We report our experience from a single institution with the use of video-assisted thoracoscopic surgery (VATS) in the management of malignant effusions. From September 1992 to April 1995, 69 patients (31 men, 38 women; age range, 38 to 76 years) underwent diagnosis and/or treatment of malignant effusions; these included 46 pleural biopsies, 34 talc insufflations, and 16 limited decortications. There was no mortality and there were no intraoperative complications. Postoperative complications occurred in seven patients (10%). Specific histologic diagnoses were obtained in all but 6 patients (87%). Malignant effusion was confirmed in 25 of 46 cases (54%). Thoracoscopic talc insufflation with or without additional decortication was successful in 32 of 34 cases (94%) in controlling recurrence of effusion after a mean follow-up of 6 months among the survivors (22 patients died during the follow-up period without effusion reaccumulation). We conclude that VATS not only provides an accurate diagnosis but also allows effective therapeutic procedures to be performed for malignant effusions that are associated with an acceptable morbidity.

Adult↗

PubMed1996

[Current treatment strategy in malignant pleural effusion].

Malignant pleural effusions are a grave consequence of advanced cancer disease. The successful suppression of pleural fluid reaccumulation can make a major contribution to the management and palliative care of patients with disseminated cancer. Many treatment concepts have been reported in the literature. The recommended therapy in malignant pleural effusions consists of intrapleural instillation of a sclerotic agent to produce pleurodesis. Different substances have been used, including tetracyclines, cytostatic agents, fibrin, talc, Corynebacterium parvum, cytokines and others. We reviewed the most frequently used techniques of pleurodesis in order to define the most effective treatment concept. In 15 prospective randomized trials the success rates varied from 13% with bleomycin to 100% with talc or Corynebacterium parvum. Talc was superior to other agents in 6 of 6, Corynebacterium parvum in 3 of 4 and bleomycin or tetracycline only in 3 of 8 studies. Adverse effects were frequently observed with cytostatic agents, but were very rare in the case of talc or fibrin instillation. Comparing the recently published data pleurodesis with talc appears to be the most effective treatment strategy, followed by Corynebacterium parvum, bleomycin and tetracycline.

Antibiotics, Antineoplastic↗

PubMed1995

Management of malignant pleural effusions.

Malignant pleural effusions are a common complication of advanced cancer, particularly breast and lung cancers. Clinical algorithms for the diagnosis and management of malignant pleural effusions form a framework for the cost-effective provision of meaningful palliation. When the entire episode of care is considered, the optimal therapy for malignant pleural effusions appears to be tube thoracostomy followed by intrapleural bleomycin. Alternative strategies for the delivery of intrapleural therapy (eg, soft catheters) and new intrapleural agents currently are being compared with standard therapy.

Algorithms↗

PubMed2001

Management of malignant pleural effusion.

Malignant pleural effusion, an abnormal accumulation of fluid in the intrapleural space, is a common complication of cancer resulting in debilitating symptoms including dyspnea, pain, and fatigue. The goal of treatment is aimed at symptomatic control, relief and control of dyspnea, and obliteration of the intrapleural space to prevent reaccumulation of pleural fluid. Treatment options include chemotherapy, radiation, intrapleural instillation of sclerosing agents, indwelling pleural catheters with intermittent drainage, pleuroperitoneal shunts, and pleurectomy. Therapeutic approaches used in the management of malignant effusions must be directed at maintaining or improving the quality of life for the individual.

Catheters, Indwelling↗

PubMed2004

Efficacious pleurodesis with OK-432 and doxorubicin against malignant pleural effusions.

Malignant pleural effusion develops frequently in patients with advanced lung cancer. Chemical pleurodesis is the most effective palliative treatment for these patients. The efficacy of pleurodesis using both OK-432, a preparation of Streptococcus pyogenes, and doxorubicin for 20 patients with cytology-proven malignant pleural effusion associated with lung cancer was evaluated. After complete removal of pleural effusion, OK-432 and 30 mg of doxorubicin were injected via an inserted chest tube. Treatment was terminated when the volume of daily drainage reached <200 mL. If the daily volume remained >200 mL, an additional OK-432 was administered every 3 days. In total, 16 patients (80%) revealed a complete response, two patients (10%) revealed a partial response, and no response was seen in two patients. Eighteen patients with complete or partial responses did not show subsequent reaccumulation of pleural effusion after pleurodesis. The chest tube remained in place for an average of 6.4 days, draining a mean of 2,854 mL. The main side-effects were fever and pain that were easily treated with nonsteroidal anti-inflammatory drugs. Pleurodesis using both OK-432 and doxorubicin showed high efficacy for controlling malignant pleural effusions caused by lung cancer.

Adult↗

PubMed2005

[Management of malignant pleural effusions].

Malignant pleural effusions with dyspnoea as their most common presenting symptom are a frequent clinical problem in patients with neoplastic disease. Lung carcinoma is the leading cause, followed by breast carcinoma and malignant lymphoma. The frequency of malignant mesothelioma is increasing in industrialized countries. In this overview, which is based on the ERS/ATS Statement 2001, the diagnostic approach, the differential diagnosis including causes of paramalignant effusions, as well as the therapeutic possibilities are described. Pleurodesis is the most important therapeutic modality, today preferably via thoracoscopic talc poudrage. Alternative local and systemic treatment options are discussed in detail. A special emphasis is put on the epidemiology, diagnosis, treatment, and prognosis of malignant effusions in patients with lung and breast carcinomas, and with lymphomas. Finally, open questions are listed which need future research, which will hopefully improve the treatment and prognosis of malignant pleural effusions.

Breast Neoplasms↗

PubMed1991

Experience with intrapleural natural beta interferon in the treatment of malignant pleural effusions.

Malignant pleural effusion is a common complication of cancer. Intrapleural beta interferon has been recently tested, and responses were obtained in about 1/3 of the patients without considerable side effects. We treated 22 patients with recurrent symptomatic malignant pleural effusions with intrapleural beta interferon at increasing doses (5-15 million units) for a maximum of three courses and obtained only two responses. In our opinion, this schedule cannot be recommended for routine use.

Aged↗

PubMed2001

Malignant pleural effusions.

Malignant pleural effusions contribute to considerable morbidity in cancer patients and generally portend an overall poor prognosis. Treatment of malignant pleural effusions is palliative; therefore, quality of life issues, as well as the risks and benefits of the therapeutic options, become more critical. In my opinion, factors such as in patient versus outpatient management and associated procedural discomfort are important in the decision-making process, and the patient should participate in these subjective considerations. It is difficult to compare results and determine the true efficacy of different techniques and agents because endpoints and response criteria as well as the extent and method of follow-up vary. In addition, the etiology of the primary complaint, dyspnea, is frequently multifactorial. However, malignant effusions recur, and therefore repeated thoracentesis, especially if the fluid rapidly reaccumulates, is usually not a good long-term solution unless the patient's overall prognosis and current condition prohibits a more invasive option. The standard option for recurrent effusions is insertion of a chest tube. If the lung re-expands, chemical pleurodesis is attempted to achieve adherence of the visceral to the parietal pleura. Sterilized talc is the best sclerosant; it has good efficacy and cost effectiveness and can be administered easily as a slurry at the bedside via a chest tube with minimal patient discomfort and without more aggressive and invasive procedures.

Humans↗

PubMed1999

Treatment of malignant pleural effusions.

Malignant pleural effusions are common in cancer patients with advanced disease. These patients usually present with chest pain, cough, and progressive shortness of breath, all of which may cause significant impairment in quality of life. Therapeutic options include systemic treatment; thoracentesis; or, most commonly, tube drainage and sclerotherapy. These procedures are usually palliative and are performed depending on patients' symptoms, underlying medical conditions, extent of disease, performance status, and prognosis. This review focuses on the diagnosis and treatment of patients with malignant pleural effusions.

Adult↗

PubMed2006

Autocrine IL-6-induced Stat3 activation contributes to the pathogenesis of lung adenocarcinoma and malignant pleural effusion.

Malignant pleural effusion (MPE) is a poor prognostic sign for patients with non-small-cell lung cancer (NSCLC). The generation of MPE is largely regulated by vascular endothelial growth factor (VEGF), and upregulation of VEGF by Stat3 has been observed in several types of tumor cells. In this study, we demonstrate constitutively activated Stat3 in several human lung cancer cell lines and in tumor cells infiltrated in the pleurae of patients with adenocarcinoma cell lung cancer (ADCLC) and MPE. The observations suggest that activated Stat3 plays a role in the pathogenesis of ADCLC. In PC14PE6/AS2 cells, a Stat3-positive human ADCLC cell line, autocrine IL-6 activated Stat3 via JAKs, not via Src kinase. PC14PE6/AS2 cells express higher VEGF mRNA and protein than do Stat3-negative PC14PE6/AS2/dnStat3 cells. In an animal model, PC14P6/AS2/dnStat3 cells produced no MPE and less lung metastasis than did PC14P6/AS2 cells. PC14PE6/AS2 cells also expressed higher VEGF protein, microvessel density, and vascular permeability in tumors than did PC14P6/AS2/dnStat3 cells. Therefore, we hypothesize that autocrine IL-6 activation of Stat3 in ADCLC may be involved in the formation of malignant pleural effusion by upregulating VEGF. Higher levels of IL-6 and VEGF were also found in the pleural fluids of patients with ADCLC than in patients with congestive heart failure. The autocrine IL-6/Stat3/VEGF signaling pathway may also be activated in patients with ADCLC and MPE. These findings provide novel targets for the management of MPE.

Adenocarcinoma↗

PubMed1989

[Comparison of the effectiveness and adverse effects of a Corynebacterium parvum vaccine made in Czechoslovakia with Coparvax, a British preparation made by Wellcome, in the treatment of malignant pleural effusions].

Malignant pleural effusion complicates various malignant diseases, most frequently lung and breast cancer. A group of 20 patients with this complication were treated with the Czechoslovak vaccine Corynebacterium parvum and the English preparation Coparvax, and their effects and side-effects were compared. Within 4 weeks following the application, 7 patients died. In 9 surviving patients, the exudate ceased to be replenished and in 4 persons, after intrapleural application of the preparation, it had to be evacuated one more time, but then its formation ceased. The therapeutical effect of both the Czechoslovak and English preparations was satisfactory. The side-effects of both preparations were comparable except for a significantly higher temperature elicited by the Czechoslovak vaccine. Both preparations Corynebacterium parvum are suitable for palliative treatment of malignant pleural exudates.

Bacterial Vaccines↗

PubMed1992

A phase I-II study of recombinant intrapleural alpha interferon in malignant pleural effusions.

Malignant pleural effusion is a common and significant source of morbidity for many patients with cancer. In an attempt to control this condition without using chest tube drainage, we administered recombinant interferon alpha-2b (INTRON, Schering-Plough, Kenilworth, NJ) intrapleurally via catheter after routine thoracentesis. Twenty-two installations of interferon were administered to 15 patients in incremental dosages of 3-50 x 10(6) U/m2. Of 20 evaluable treatments, six (30%) achieved effusion stabilization; there were no complete or partial responses. Only one of nine treatments at a dosage less than 20 x 10(6) units/m2 resulted in symptoms, while four of 11 treatments at the higher dosage were associated with transient fever, chills, and chest pain. Interferon demonstrated no major activity in this heavily treated patient population with advanced malignancy.

Adult↗

PubMed2004

Management of malignant pleural effusions.

Malignant pleural effusion is a common clinical problem. Evacuation of the pleural fluid and prevention of its reaccumulation are the main aims of management. Pleurodesis should be attempted early, although considerable practice variations exist in the way it is performed. There is a lack of consensus among respiratory physicians worldwide on the optimal method and agent for pleurodesis. Talc remains the most commonly used pleurodesing compound in most countries. While talc produces a higher success rate than other compounds, it generates more side-effects. The association between talc and ARDS continues to be debated. Ambulatory small-bore pleural catheter drainage followed by intrapleural instillation of a pleurodesing agent is increasingly accepted as an alternative to conventional in-patient pleurodesis. Development of novel methods to control pleural fluid formation should be made a high priority in future pleural research.

Humans↗

PubMed1998

Management of malignant pleural effusion.

Malignant pleural effusion is a frequent cause of morbidity in cancer patients. Pleural aspiration relieves dyspnoea usually only for a matter of days, and if the tumour type is not chemosensitive, some form of pleurodesis is commonly required. Tube thoracostomy is widely used to achieve pleural drainage prior to attempting pleurodesis by instillation of a variety of 'sclerosants'. Recently thoracoscopic instillation of talc has been advocated and some authors report high rates of fluid control. Randomised trials comparing this approach compared to tube thoracostomy and chemical pleurodesis are required.

Chest Tubes↗

PubMed2003

[Clinical value of tumor supplied group of factor combined with CEA in diagnosing tuberculosis pleural effusion and malignant pleural effusion].

OBJECTIVES: To determine the clinical value of tumor supplied group of factor (TSGF) combined with carcinoembryonic antigen (CEA) in diagnosing tukerculosis pleural effusion and malignant pleurul effusion. METHODS: TSGF and CEA were detected by ELISA in 14 patients with tuberculosis pleural effusion and 28 patients with malignant pleural effusion. RESULTS: The average levels of TSGF and CEA in patients with malignant pleural effusion were higher than those with tuberculosis pleural effusion. The diagnostic sensitivity of TSGF and CEA in the malignant pleural effusion was 67.5% and 57.5%, the specificity was 85.7% and 78.6%, and the agreement rate was 72.2% and 62.9% respectively; while the sensitivity, specificity and agreement rate of TSGF combined with CEA were 93%, 67.4%, and 88.9%. CONCLUSION: The sensitivity and agreement rate of TSGF combined with CEA are higher than those of either of the two methods. TSGF combined with CEA is important in differentiating tuberculosis and malignant pleural effusion.

Adult↗