Contemporary approach to the patient with malignant pleural effusion complicating lung cancer

Abstract

Malignant pleural effusion (MPE) occurring in the patient with lung cancer can have profound prognostic and management implications. If clinically relevant, such an effusion first needs to be confirmed as malignant and then, in the majority of lung cancer patients, it will require a pleural intervention to relieve symptoms related to fluid accumulation. The field of pleural diseases in general, and pleural malignancy in particular, has undergone dynamic changes in recent years as the evidence base informing practice has grown by leaps and bounds. Both the diagnosis and management of MPE are dynamically changing disciplines in thoracic medicine. As commonly happens, emerging data have generated just as many questions as they have answered. The aim of the present review is to summarize the current knowledge about MPE resulting from lung cancer in a manner that is accessible to clinicians across medical specialties.

Keywords: Pleural effusion; indwelling pleural catheter (IPC); lung cancer; pleurodesis; thoracoscopy.

Figure 1

An example of an indwelling pleural catheter.

Figure 2

Management of patients with known or suspected MPE. *, with goals of assessing lung expansion and relief of dyspnea. This step may not be necessary if the patient’s dyspnea is known to be attributable to the MPE; **, the recommendation of “Predicted very short survival” should be used as a rough guideline and individualized on a case-by-case basis; ***, there is a low likelihood of IPC—related infection. Escalation of care (intravenous antibiotics, hospital admission, removal of catheter) should be made on a case-by-case basis and is recommended if there are any signs/symptoms of worsening infection. Adapted from Ref. . Reprinted with permission of the American Thoracic Society. Copyright^© 2018 American Thoracic Society. MPE, malignant pleural effusion; IPC, indwelling pleural catheter