Chronic and recurrent pleural effusion (PE) in malignant diseases is a common cause of dyspnea, cough and chest pain. The vast majority is malignant pleural effusion (MPE), nevertheless disease-associated but not directly disease-caused paramalignant pleural effusions (PPE) have also been described. Talc pleurodesis had been the only treatment option for decades, while for 20 years indwelling pleural catheters (IPC) have emerged as an alternative leading to spontaneous pleurodesis without any chemical agent in 40-50%.
Our aim is to explore patient characteristics, procedural variables and outcomes in a large population of patients with IPC due to PE in malignancy. Further, our objective is to identify factors associated with outcome.
From 2006 until 2016 448 IPC were inserted in 395 patients, 52 received bilateral drainages (12.7%). 77.0% of the effusions were malignant (n = 304), 14.9% paramalignant (n = 59), in 8.1% the etiology could not be clarified (n = 32). The most common underlying diseases were ovarian cancer (30.6%, 121 patients), lung cancer (23.0%, 91 patients) and breast cancer (11.4%, 45 patients). The median length of insertion was 1.2 months (0.03-23.6), the median survival time after insertion 2.4 months (lung cancer 1.6 months, ovarian cancer 2.8 months, breast cancer 4.0 months). Spontaneous pleurodesis was observed in 28.6% (128/448 catheters) and was significantly associated with overall survival (HR 0.54, 95%-CI 0.39-0.75, p
In conclusion, our retrospective series is the largest to date to report on IPC in malignancy and showed a manageable safety profile. Spontaneous pleurodesis was significantly associated with survival.
Clinical trial identification
Legal entity responsible for the study
Charité Universitätsmedizin Berlin
All authors have declared no conflicts of interest.