PURPOSE: To describe the usefulness of indwelling pleural catheters in the palliative management of recurrent symptomatic chylothorax in cancer patients.
METHODS: Retrospective analysis of patients with pleural effusion and cancer who underwent intrapleural catheter placement between November of 1997 and April of 2006. Patients with triglyceride level above 110 mg/dl were identified. Clinical characteristics, ECOG performance status (PS), lung re-expansion, symptomatic improvement, time to removal of indwelling pleural catheter, nutritional status, complications and survival were reviewed.
RESULTS: Fourteen hundred and ninety seven patients underwent indwelling pleural catheter placement. Nine chylothoraces were identified. Primary cancers were lymphoma=3, renal cell carcinoma=2, chronic lymphocytic leukemia=1, lung adenocarcinoma=1, mesothelioma=1 and adenocarcinoma of unknown primary=1. Eight patients were males. Median age 65 years old. Four patients were alive at the time of the review. Four patients with ECOG PS of 3 or worse died with the indwelling intrapleural catheter in place. Median time from catheter placement to death was 28 days. This group of patients had a median decrease on serum albumin of 38%. Five patients had an ECOG PS of 2 or better. Two patients had the catheter removed; one of them had an empyema and the other stopped draining fluid. They achieved pleurodesis at 29 and 23 days respectively. The remaining three patients had the catheter in place at the time of the review with rapidly decreasing draining volumes. Median albumin decrease in this group was 9%. Median weight loss was 4%. All patients but one with trapped lung due to mesothelioma obtained good lung re-expansion. All patients experienced symptomatic relief.
CONCLUSION: Patients with good ECOG PS experienced mild weight loss and mild decrease in albumin. Pleurodesis was obtained within a month in this group. All patients experienced symptomatic relief. There were no complications associated with the catheter placement. One empyema was successfully treated.
CLINICAL IMPLICATIONS: Indwelling pleural catheter is a good alternative to palliate recurrent symptomatic chylothorax associated with cancer especially in patients with good ECOG PS.
DISCLOSURE: Ashwini Mhatre, None.