Effect Of Fluid Biochemistry On Bleomycin Pleuredesia In Non-Mesothelioma Malign Pleural Effusions
Non-Mesothelioma Malign Pleural Effusions
DOI:
https://doi.org/10.5281/zenodo.13898176Keywords:
Malign plevral efüzyonlar, video yardımlı torakoskopik cerrahi, yaşam kalitesi, adenokarsinom, plöredezAbstract
Objective: Malignant pleural effusions (MPE) often signal terminal-stage malignancy, with limited survival and quality of life prospects. This study aimed to evaluate whether fluid biochemistry influences recurrence after bleomycin pleurodesis in patients diagnosed with MPE through VATS pleural biopsy and fluid cytology.
Method: A total of 23 patients diagnosed with MPE due to primary lung carcinoma or pleural metastasis, and treated with bleomycin pleurodesis at our institution, were included. All diagnoses were confirmed via VATS pleural biopsy.
Results: The mean age of patients with recurrence was 52.5 years. Their mean pleural fluid values were: LDH 569.75 U/L, pH 7.5, protein 4.53 g/dL, glucose 81 mg/dL, and albumin 3.13 g/dL. The average drainage time was 10.5 days. Recurrence occurred in 20% of men and 12.5% of women, with a 20% recurrence rate on the right side and 12.5% on the left. Recurrence in pulmonary adenocarcinoma patients was 33.3%, while the overall recurrence after bleomycin pleurodesis was 17.4%. General anesthesia had a higher recurrence rate (25%) compared to local anesthesia (9.1%).
Conclusion: Recurrent pleural effusion in MPE presents a clinical challenge. VATS is a crucial tool in diagnosing and managing MPE. Bleomycin is readily available for pleurodesis in our country, but the treatment should be personalized to balance quality of life and hospitalization time. International guidelines offer valuable insights but need to be adapted to individual cases.
Keywords: Malignant pleural effusions, video-assisted thoracoscopic surgery, quality of life, adenocarcinoma, pleurodesis
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Jia J, Marazioti A, Voulgaridis A, et al. Clinical identification of malignant pleural effusions. Transl Oncol. 2024;39:101800. doi:10.1016/j.tranon.2023.101800
Gonnelli F, Hassan W, Bonifazi M, et al. Malignant pleural effusion: current understanding and therapeutic approach. Respir Res. 2024;25(1):47. Published 2024 Jan 19. doi:10.1186/s12931-024-02684-7
Shen-Wagner J, Gamble C, MacGilvray P. Pleural Effusion: Diagnostic Approach in Adults. Am Fam Physician. 2023;108(5):464-475.
Kim N, Bae K, Kim HC, Jeon KN. Added value of 40 keV virtual monoenergetic images for diagnosing malignant pleural effusion on chest CT. Jpn J Radiol. Published online May 3, 2024. doi:10.1007/s11604-024-01571-x
Simó M, Persiva O, Sánchez L, et al. A PET-CT score for discriminating malignant from benign pleural effusions. Med Clin (Barc). 2023;161(10):422-428. doi:10.1016/j.medcli.2023.06.011
Lee J, Lee YH, Seo H, et al. Laboratory Discrimination Between Neutrophilic Malignant and Parapneumonic Pleural Effusions. Am J Med Sci. 2019;358(2):115-120. doi:10.1016/j.amjms.2019.04.009
Allocca V, Guidelli L, Galgano A, et al. Safety and Diagnostic Yield of Medical Pleuroscopy (MP) Performed under Balanced Analgosedation by a Pneumological Team Compared to Video-Assisted Thoracic Surgery (VATS): A Retrospective Controlled Real-Life Study (TORAPO). Diagnostics (Basel). 2024;14(6):569. Published 2024 Mar 7. doi:10.3390/diagnostics14060569
Goh KJ, Leong CK, Young SL, et al. Diagnostic value and safety of medical thoracoscopy in undiagnosed pleural effusions-a prospective observational cohort study. J Thorac Dis. 2024;16(5):3142-3151. doi:10.21037/jtd-24-219
Katlic MR, Facktor MA. Video-assisted thoracic surgery utilizing local anesthesia and sedation: 384 consecutive cases. Ann Thorac Surg 2010;90:240-5. doi: 10.1016/j.athoracsur.2010.02.113.
Eastham JA, Kelly WK, Grossfeld GD, Small EJ; Cancer and Leukemia Group B. Cancer and Leukemia Group B (CALGB) 90203: a randomized phase 3 study of radical prostatectomy alone versus estramustine and docetaxel before radical prostatectomy for patients with high-risk localized disease. Urology. 2003;62 Suppl 1:55-62. doi:10.1016/j.urology.2003.09.052
Yim AP, Chung SS, Lee TW, Lam CK, Ho JK. Thoracoscopic management of malignant pleural effusions. Chest. 1996;109(5):1234-1238. doi:10.1378/chest.109.5.1234
Lovato JB, Laroumagne S, Tronchetti J, Nguyen NAT, Dutau H, Astoul P. Fast pleurodesis combining talc poudrage and indwelling pleural catheter for the management of recurrent malignant pleural effusions. Respir Med Res. Published online June 22, 2024. doi:10.1016/j.resmer.2024.101124
Rintoul RC. The MesoVATS trial: is there a future for video-assisted thoracoscopic surgery partial pleurectomy? Future Oncol. 2015;11:15–7.
Elayouty HD, Hassan TM, Alhadad ZA. Povidone- Iodine versus Bleomycin Pleurodesis for Malignant Effusion in Bronchogenic Cancer Guided by Thoracic Echography. J Cancer Sci Ther. 2012. 4:182–184
Mierzejewski M, Korczynski P, Krenke R, Janssen JP. Chemical pleurodesis - a review of mechanisms involved in pleural space obliteration. Respir Res. 2019;20(1):247. Published 2019 Nov 7. doi:10.1186/s12931-019-1204-x
Papaioannou AI, Kostikas K, Tsopa P, et al. Residual pleural thickening is related to vascular endothelial growth factor levels in parapneumonic pleural effusions. Respiration. 2010;80(6):472-479. doi:10.1159/000270913
Penz E, Watt KN, Hergott CA, Rahman NM, Psallidas I. Management of malignant pleural effusion: challenges and solutions. Cancer Manag Res. 2017;9:229-241. Published 2017 Jun 23. doi:10.2147/CMAR.S95663
Blyth KG, Adusumilli PS, Astoul P, et al. Leveraging the pleural space for anticancer therapies in pleural mesothelioma. Lancet Respir Med. 2024;12(6):476-483. doi:10.1016/S2213-2600(24)00111-5
Awwad A, Berman Z, Minocha J. Pleurovenous Shunt Placement for the Management of Nonmalignant Pleural Effusion. Semin Intervent Radiol. 2022;39(3):248-252. Published 2022 Aug 31. doi:10.1055/s-0042-1751296
Gary Lee YC, Light RW. Future directions. In: Light RW, Gary Lee YC eds. Textbook of pleural diseases. London, England: Hodder Arnold. 2003, 536–541.
Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ; BTS Pleural Disease Guideline Group. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii32-ii40. doi:10.1136/thx.2010.136994
MacRosty CR, Wright A, Ceppe A, Ghosh S, Burks AC, Akulian JA. Pleural Fluid Resolution Is Associated with Improved Survival in Patients with Malignant Pleural Effusion. Life (Basel). 2023;13(5):1163. Published 2023 May 11. doi:10.3390/life13051163
Musso V, Diotti C, Palleschi A, Tosi D, Aiolfi A, Mendogni P. Management of Pleural Effusion Secondary to Malignant Mesothelioma. J Clin Med. 2021;10(18):4247. Published 2021 Sep 19. doi:10.3390/jcm10184247
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