Malignant Pleural Effusions: Management Options

David J. McCracken, MRCP; Jose M. Porcel, MD; Najib M. Rahman, DPhil

Disclosures

Semin Respir Crit Care Med. 2018;39(6):704-712. 

In This Article

Long-term Management: Indwelling Pleural Catheters

The current 2010 BTS Pleural Disease Guidelines place IPCs as a second-line option in the long-term management of MPE, predominantly suitable for those patients in whom talc pleurodesis is either inappropriate or has been unsuccessful. Their use in clinical practice, however, has significantly increased over the past decade and, as a result, IPCs now represent a joint first-line definitive option with the decision often based on patient preference. There is also a clear indication for first-line use in patients with unexpandable lung in whom talc pleurodesis is not indicated. The current evidence supports this position, with significant improvements in dyspnea in 86% of patients in the IPC arm of the TIME2 trial, without statistically significant differences when compared with those undergoing talc pleurodesis. There were also no statistically significant differences when comparing quality of life measurements. As previously discussed, these findings were corroborated by the AMPLE study from 2017.[1,8,9]

Despite statistically significant increases in the frequency of adverse events such as pleural infection, catheter tract metastases, and catheter displacement or blockage, IPCs provide an ambulatory treatment option allowing for the domiciliary management of MPE. This results in greater patient independence and autonomy.

Benefit has also been suggested from the statistically significant reduction in the number of subsequent pleural procedures required in those patients undergoing IPC insertion when compared with those receiving talc pleurodesis. This has been widely accepted as a positive patient-centered outcome. However, patients with an IPC in situ have their pleural space accessed often multiple times per week and although this may not considered a distinct procedure performed in hospital, equivalent to aspiration or chest drain, the clinical significance of this measurement is therefore less clear.[8,9]

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