ERS/EACTS statement on the management of malignant pleural effusions

Abstract

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.

Conflict of interest statement

Conflict of interest: A.C. Bibby reports grants from National Institute of Health Research (DRF-2016-09-065), outside the submitted work. Conflict of interest: I. Psallidas is a Medical Science Director for AstraZeneca in a different research area than the submitted work. Conflict of interest: P. Licht reports personal fees (speaker's honorarium) from Ethicon, outside the submitted work. Conflict of interest: A. Scherpereel reports personal fees (for advisory board participation) from BMS, MSD, Boehringer Ingelheim and Roche, and has been an investigator in clinical trials (fees paid to institution, CHU de Lille, France) for AstraZeneca, Lilly, BMS, MSD, Boehringer Ingelheim and Roche, outside the submitted work. Conflict of interest: N.M. Rahman reports personal fees for consultancy work from Rocket Medical UK, outside the submitted work. Conflict of interest: N.A. Maskell reports unrestricted research grants from Becton Dickinson and Rocket, outside the submitted work, and is a member of the advisory board for Becton Dickinson.

The article has been co-published with permission in the European Respiratory Journal and the European Journal of Cardio-Thoracic Surgery. All rights reserved in respect of European Respiratory Journal, © European Respiratory Society 2018 and European Journal of Cardio-Thoracic Surgery, © European Association for Cardio-Thoracic Surgery 2018. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.