SESSION TYPE: Pleural Biomarkers
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: Malignant pleural effusions (MPE) affect 150,000 patients in the US each year. Prognosis is poor and median survival about 6 months. Loculations occur frequently and surgical options are not always suitable in this group of patients. The role of intrapleural alteplase in MPE has never been studied before.
METHODS: Chart review was performed on 21 patients (32 instillations) who had received intrapleural alteplase instillations via Pleurx catheter in the last 3 years. Data was collected for amount of drainage prior to alteplase instillation, immediately after, in the first 24, 72 hours and 1 week after instillation, documentation of symptom relief in the first 24 hours and documentation of radiographic improvement upto 72 hours after alteplase instillation. Analysis was performed based on the net amount of drainage. An additional patient underwent repeated weekly intrapleural alteplase.
RESULTS: Mean drainage before alteplase instillation was 158.75 cc and in the first 24 hours after alteplase was 714.38 cc with a mean difference of 549.38 cc (p=0.0021). Mean difference between before and 72 hours after alteplase instillation was 241.25 cc (p=0.031). There was no significant difference between drainage before and 1 week after alteplase instillation. 59% of patients had symptomatic improvement in the first 24 hours after alteplase instillation. Radiographic improvement was seen only in 22% of cases. No complications were reported. One patient not included in the above analysis underwent weekly outpatient intrapleural alteplase instillation via Pleurx catheter for a loculated left pleural effusion and significantly improved drainage was seen each time for upto 48 hours after each instillation. Symptom relief lasted for 5-7 days. No complications were seen after the 10 instillations so far.
CONCLUSIONS: Maintaining quality of life is the main goal in MPE. This study demonstrates safety and efficacy of intrapleural alteplase instillation in achieving significant drainage for upto 3 days. Repeated instillation in an outpatient setting is safe and may achieve sustained results over duration of time. Significant radiographic improvement is not always seen.
CLINICAL IMPLICATIONS: This study demonstrates the safety and efficacy of intrapleural alteplase in loculated MPE in achieving significant drainage as well as symptomatic improvement, in both inpatient and outpatient settings. Surgical options may be avoided in this group of patients where palliation is the main goal.
DISCLOSURE: The following authors have nothing to disclose: Satish Kalanjeri, Mohit Chawla, Nicholas Vander Els, Diane Stover, Robert Lee
No Product/Research Disclosure InformationPulmonary Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY