Safety of indwelling pleural catheter use in patients undergoing chemotherapy: a five-year retrospective evaluation

Charleen Chan Wah Hak, Parthipan Sivakumar, Liju Ahmed, Charleen Chan Wah Hak, Parthipan Sivakumar, Liju Ahmed

Abstract

Background: Indwelling pleural catheters (IPC) are increasingly becoming a first-line treatment in the management of malignant pleural effusions. Ambulatory management using IPC are increasingly used in this patient group whilst they are receiving concurrent chemotherapy. There are currently no prospective trials examining IPC safety in chemotherapy. This study's objective is to determine if IPC insertion is safe in patients undergoing chemotherapy.

Methods: We conducted a retrospective analysis of all patients who underwent IPC insertion for malignant pleural effusion at our trust from September 2010 to December 2014. Data was collected on IPC insertion and removal, tumour type, systemic chemotherapy, pleural infection and other complications.

Results: One hundred four patients were identified, 43 in chemotherapy group and 61 in non-chemotherapy group. The incidence of pleural infection in chemotherapy group vs non-chemotherapy group, 4 (9.3%) vs 3 (4.9%) respectively, was not statistically different (Fisher's exact p = 0.311). There was no significant difference in six-month infection-free duration from the date of IPC insertion (log rank p = 0.394). Overall six-month mortality in chemotherapy group was significantly lower than in non-chemotherapy group (log rank p = 0.007).

Conclusions: This is the second largest retrospective case-control series that concludes systemic chemotherapy is safe in patients with IPC undergoing chemotherapy.

Keywords: Antineoplastic agents; Catheters; Indwelling; Malignant; Pleura; Pleural effusion.

Figures

Fig. 1
Fig. 1
Time to pleural infection over six-months between chemotherapy and non-chemotherapy groups (Kaplan-Meier). Event: pleural infection. Blue line: non-chemotherapy group; Green line: chemotherapy group
Fig. 2
Fig. 2
Six-month mortality data between chemotherapy and non-chemotherapy groups (Kaplan-Meier). Event: patient death. Blue line: non-chemotherapy group; Green line: chemotherapy group

References

    1. Muduly D, Deo S, Subi T, Kallianpur A, Shukla N. An update in the management of malignant pleural effusion. Indian J Palliat Care. 2011;17:98–103. doi: 10.4103/0973-1075.84529.
    1. Rahman NM, Ali NJ, Brown G, Chapman SJ, Davies RJ, Downer NJ, et al. Local anaesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii54–60.
    1. Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan-Evans N, et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014;69:1098–104. doi: 10.1136/thoraxjnl-2014-205285.
    1. Davies HE, Mishra EK, Kahan BC, Wrightson JM, Stanton AE, Guhan A, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA. 2012;307:2383–9. doi: 10.1001/jama.2012.5535.
    1. Dresler CM, Olak J, Herndon JE, 2nd, Richards WG, Scalzetti E, Fleishman SB, et al. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest. 2005;127:909–15. doi: 10.1378/chest.127.3.909.
    1. Schniewind B, Rose T, Woltmann N, Walter J, Becker T, Dohrmann P, et al. Clinical outcomes and health-related quality of life after thoracoscopic talc pleurodesis. J Palliat Med. 2012;15:37–42. doi: 10.1089/jpm.2011.0149.
    1. Bhatnagar R, Maskell NA. Indwelling pleural catheters. Respiration. 2014;88:74–85. doi: 10.1159/000360769.
    1. Putnam JB, Walsh GL, Swisher SG, Roth JA, Suell DM, Vaporciyan AA, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg. 2000;69:369–75. doi: 10.1016/S0003-4975(99)01482-4.
    1. Ahmed L, Ip H, Rao D, Patel N, Noorzad F. Talc pleurodesis through indwelling pleural catheters for malignant pleural effusions: retrospective case series of a novel clinical pathway. Chest. 2014;146:e190–4. doi: 10.1378/chest.14-0394.
    1. Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest. 2006;129:362–8. doi: 10.1378/chest.129.2.362.
    1. van den Toorn LM, Schaap E, Surmont VF, Pouw EM, van der Rijt KC, van Klaveren RJ. Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter. Lung Cancer. 2005;50:123–7. doi: 10.1016/j.lungcan.2005.05.016.
    1. Warren WH, Kalimi R, Khodadadian LM, Kim AW. Management of malignant pleural effusions using the Pleur(x) catheter. Ann Thorac Surg. 2008;85:1049–55. doi: 10.1016/j.athoracsur.2007.11.039.
    1. Mekhaiel E, Kashyap R, Mullon JJ, Maldonado F. Infections associated with tunnelled indwelling pleural catheters in patients undergoing chemotherapy. J Bronchol Interv Pulmonol. 2013;20:299–303. doi: 10.1097/LBR.0000000000000001.
    1. Morel A, Mishra E, Medley L, Rahman NM, Wrightson J, Talbot D, et al. Chemotherapy should not be withheld from patients with an indwelling pleural catheter for malignant pleural effusion. Thorax. 2011;66:448–9. doi: 10.1136/thx.2009.133504.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere