Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review

Margaret E M Van Meter, Kanako Y McKee, R Jeffrey Kohlwes, Margaret E M Van Meter, Kanako Y McKee, R Jeffrey Kohlwes

Abstract

Background: Malignant pleural effusions (MPE) are a frequent cause of dyspnea and discomfort at the end of cancer patients' lives. The tunneled indwelling pleural catheter (TIPC) was approved by the FDA in 1997 and has been investigated as a treatment for MPE.

Objective: To systematically review published data on the efficacy and safety of the TIPC for treatment of MPE.

Design: We searched the MEDLINE, EMBASE, and ISI Web of Science databases to identify studies published through October 2009 that reported outcomes in adult patients with MPE treated with a TIPC. Data were aggregated using summary statistics when outcomes were described in the same way among multiple primary studies.

Main measures: Symptomatic improvement and complications associated with use of the TIPC.

Key results: Nineteen studies with a total of 1,370 patients met criteria for inclusion in the review. Only one randomized study directly compared the TIPC with the current gold standard treatment, pleurodesis. All other studies were case series. Symptomatic improvement was reported in 628/657 patients (95.6%). Quality of life measurements were infrequently reported. Spontaneous pleurodesis occurred in 430/943 patients (45.6%). Serious complications were rare and included empyema in 33/1168 patients (2.8%), pneumothorax requiring a chest tube in 3/51 (5.9%), and unspecified pneumothorax in 17/439 (3.9%). Minor complications included cellulitis in 32/935 (3.4%), obstruction/clogging in 33/895 (3.7%) and unspecified malfunction of the catheter in 11/121 (9.1%). The use of the TIPC was without complication in 517/591 patients (87.5%).

Conclusions: Based on low-quality evidence in the form of case series, the TIPC may improve symptoms for patients with MPE and does not appear to be associated with major complications. Prospective randomized studies comparing the TIPC to pleurodesis are needed before the TIPC can be definitively recommended as a first-line treatment of MPE.

Figures

Figure 1
Figure 1
Article selection process. Abbreviations: WoS, Web of Science; VATS, video-assisted thoracoscopic surgery
Figure 2
Figure 2
Outcomes reported in patients treated with the TIPC

References

    1. Antony VB, Loddenkemper R, Astoul P, et al. Management of malignant pleural effusions. American Journal of Respiratory and Critical Care Medicine. 2000;162:1987–2001.
    1. Dresler CM, Olak J, Herndon JE, 2nd, 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. Rehse DH, Aye RW, Florence MG. Respiratory failure following talc pleurodesis. Am J Surg. 1999;177:437–40. doi: 10.1016/S0002-9610(99)00075-6.
    1. Davies HE, Lee YC, Davies RJ. Pleurodesis for malignant pleural effusion: talc, toxicity and where next? Thorax. 2008;63:572–4. doi: 10.1136/thx.2007.092940.
    1. Michaud G, Barclay P, Tremblay A. Tunneled pleural catheters for palliation of malignant pleural effusions. Journal of Bronchology. 2005;12:245–8. doi: 10.1097/01.lab.0000185782.99433.02.
    1. Putnam JB, Jr, Light RW, Rodriguez RM, et al. A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions. Cancer. 1999;86:1992–9. doi: 10.1002/(SICI)1097-0142(19991115)86:10<1992::AID-CNCR16>;2-M.
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Schunemann HJ. GRADE: an emerging consensus on rating quality evidence and strength of recommendations. BMJ. 2008;336:924–6. doi: 10.1136/.
    1. Bertolaccini L, Zamprogna C, D'Urso A, Massaglia F. The treatment of malignant pleural effusions: the experience of a multidisciplinary thoracic endoscopy group. Tumori. 2003;89:233–6.
    1. Burgers JA, Olijve A, Baas P. Chronic indwelling pleural catheter for malignant pleural effusion in 25 patients. Ned Tijdschr Geneeskd. 2006;150:1618–23.
    1. Bertolaccini L, Lyberis P, Manno E, Massaglia F. Management of malignant pleural effusion by chronic indwelling pleural catheter. Lung Cancer. 2009;64:S64. doi: 10.1016/S0169-5002(09)70276-4.
    1. Bertolaccini L, Zamprogna C, Barberis L, et al. Malignant pleural effusions: review of treatment and our experience. Rev Recent Clin Trials. 2007;2:21–5. doi: 10.2174/157488707779318080.
    1. Tremblay A, Mason C, Michaud G. Use of tunnelled catheters for malignant pleural effusions in patients fit for pleurodesis. Eur Respir J. 2007;30:759–62. doi: 10.1183/09031936.00164706.
    1. Tremblay A, Michaud GC. Single center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest. 2005;128:321S.
    1. Tremblay A, Patel M, Michaud G, Mellor J, Grondin S. Use of indwelling pleural catheters in malignant pleural effusions secondary to mesothelioma. Chest. 2004;126:735S.
    1. Tremblay A, Patel M, Michaud G. Use of tunneled pleural catheters in malignant mesothelioma. J Bronchology. 2005;12:203–6. doi: 10.1097/01.laboratory.0000188644.81416.3c.
    1. Warren WH, Kalimi R, Khodadadian LM, Kim AW. Management of malignant pleural effusions using the Pleurx catheter. Ann Thorac Surg. 2008;85:1049–55. doi: 10.1016/j.athoracsur.2007.11.039.
    1. Mullett TW, Bernard AC, Arnold SM, Freedman KO. Treatment of malignant pleural effusion using indwelling drains. Annals of Surgical Oncology. 2003;10:S80. doi: 10.1245/ASO.2003.04.010.
    1. Wyckoff CC, Anderson ED, Read CA. The Pleurx catheter for the management of symptomatic, recurrent malignant pleural effusions: The Georgetown experience. Chest. 2003;124:130S.
    1. Diez-Porres L, Alonso-Babarro A, Iglesias-Docampo A, Diaz-Agero P. Outpatient management of malignant pleural effusion with chronic pleural catheter. Palliat Med. 2008;22:775–6. doi: 10.1177/0269216308095020.
    1. Robinson RD, Fullerton DA, Albert JD, Sorensen J, Johnston MR. Use of pleural Tenckhoff catheter to palliate malignant pleural effusion. Ann Thorac Surg. 1994;57:286–8. doi: 10.1016/0003-4975(94)90984-9.
    1. Al-Halfawy A, Light R. Safety and efficacy of using a surgivac pump for the drainage of chronic indwelling pleural catheters in malignant pleural effusions. Respirology. 2008;13:461–4. doi: 10.1111/j.1440-1843.2008.01238.x.
    1. Putnam JB, Jr, Walsh GL, Swisher SG, 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. Murthy SC, Okereke I, Mason DP, Rice TW. A simple solution for complicated pleural effusions. J Thorac Oncol. 2006;1:697–700. doi: 10.1097/01243894-200609000-00016.
    1. Schneider T, Reimer P, Storz K, et al. Recurrent pleural effusion: who benefits from a tunneled pleural catheter? Thorac Cardiovasc Surg. 2009;57:42–6. doi: 10.1055/s-2008-1039109.
    1. Sioris T, Sihvo E, Salo J, Rasanen J, Knuuttila A. Long-term indwelling pleural catheter (PleurX) for malignant pleural effusion unsuitable for talc pleurodesis. Eur J Surg Oncol. 2009;35:546–51.
    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. Ohm C, Park D, Vogen M, et al. Use of an indwelling pleural catheter compared with thorascopic talc pleurodesis in the management of malignant pleural effusions. Am Surg. 2003;69:198–202.
    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. Bazerbashi S, Villaquiran J, Awan MY, Unsworth-White MJ, Rahamim J, Marchbank A. Ambulatory intercostal drainage for the management of malignant pleural effusion: a single center experience. Ann Surg Oncol. 2009;16:3482–7. doi: 10.1245/s10434-009-0691-2.
    1. Musani AI, Haas AR, Seijo L, Wilby M, Sterman DH. Outpatient management of malignant pleural effusions with small-bore, tunneled pleural catheters. Respiration. 2004;71:559–66. doi: 10.1159/000081755.
    1. Pollak JS, Burdge CM, Rosenblatt M, Houston JP, Hwu WJ, Murren J. Treatment of malignant pleural effusions with tunneled long-term drainage catheters. J Vasc Interv Radiol. 2001;12:201–8. doi: 10.1016/S1051-0443(07)61826-0.
    1. Pien GW, Gant MJ, Washam CL, Sterman DH. Use of an implantable pleural catheter for trapped lung syndrome in patients with malignant pleural effusion. Chest. 2001;119:1641–6. doi: 10.1378/chest.119.6.1641.
    1. Warren WH, Kim AW, Liptay MJ. Identification of clinical factors predicting Pleurx catheter removal in patients treated for malignant pleural effusion. Eur J Cardiothorac Surg. 2008;33:89–94. doi: 10.1016/j.ejcts.2007.10.002.
    1. Heffner JE, Nietert PJ, Barbieri C. Pleural fluid pH as a predictor of survival for patients with malignant pleural effusions. Chest. 2000;117:79–86. doi: 10.1378/chest.117.1.79.
    1. Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest. 2009;136:260–71. doi: 10.1378/chest.08-0978.
    1. Antunes G, Neville E, Duffy J, Ali N. BTS guidelines for the management of malignant pleural effusions. Thorax. 2003;58(Suppl 2):ii29–38.
    1. Tremblay A. Management of malignant pleural effusions—PleurX catheter placement. Journal of Thoracic Oncology. 2009;4:S202–3.
    1. Musani AI. Treatment options for malignant pleural effusion. Curr Opin Pulm Med. 2009;15:380–7. doi: 10.1097/MCP.0b013e32832c6a8a.
    1. Lombardi G, Zustovich F, Nicoletto MO, Donach M, Artioli G, Pastorelli D. Diagnosis and treatment of malignant pleural effusion: a systematic literature review and new approaches. Am J Clin Oncol 2009 Oct 23 [Epub ahead of print].
    1. Stather DR, Tremblay A. Use of tunneled pleural catheters for outpatient treatment of malignant pleural effusions. Curr Opin Pulm Med. 2007;13:328–33. doi: 10.1097/MCP.0b013e328121447d.
    1. Caglayan B, Torun E, Turan D, et al. Efficacy of iodopovidone pleurodesis and comparison of small-bore catheter versus large-bore chest tube. Ann Surg Oncol. 2008;15:2594–9. doi: 10.1245/s10434-008-0004-1.
    1. Wyckoff CC, Anderson ED, Read CA, Lee RE. The use of intrapleural doxycycline via pleurx catheter in the treatment of malignant pleural effusions: Preliminary report. Chest. 2007;132:432S.
    1. Porcel JM, Salud A, Nabal M, Vives M, Esquerda A, Rodriguez-Panadero F. Rapid pleurodesis with doxycycline through a small-bore catheter for the treatment of metastatic malignant effusions. Support Care Cancer. 2006;14:475–8. doi: 10.1007/s00520-005-0001-x.
    1. Olden AM, Holloway R. Treatment of malignant pleural effusion: PleuRx® catheter or talc pleurodesis? A cost-effectiveness analysis. J Palliat Med. 2010;13:59–65. doi: 10.1089/jpm.2009.0220.

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