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Original Research: Pulmonary Procedures |

Catheter Tract Metastasis Associated With Indwelling Pleural CathetersCatheter Tract Metastasis

Rajesh Thomas, MBBS; Charley A. Budgeon, BSc (Hons); Yi Jin Kuok, MBBS; Catherine Read, BSc (Hons); Edward T. H. Fysh, MBBS; Sean Bydder, MBChB; Y. C. Gary Lee, PhD, FCCP
Author and Funding Information

From the Department of Respiratory Medicine (Drs Thomas and Lee), the Department of Research (Ms Budgeon), the Department of Radiology (Dr Kuok), and the Department of Radiation Oncology (Dr Bydder), Sir Charles Gairdner Hospital; the School of Medicine and Pharmacology (Drs Thomas, Fysh, and Lee), and the Centre for Applied Statistics (Ms Budgeon), University of Western Australia; and the Lung Institute of Western Australia (Drs Thomas, Fysh, and Lee and Ms Read), Perth, WA, Australia.

CORRESPONDENCE TO: Y. C. Gary Lee, PhD, FCCP, UWA School of Medicine & Pharmacology, 533, Harry Perkins Research Bldg, QE II Medical Centre, Perth, WA 6009, Australia; e-mail: gary.lee@uwa.edu.au


FUNDING/SUPPORT: Drs Fysh and Lee have received research grant support from the Sir Charles Gairdner Research Foundation, Cancer Council of Western Australia, Lung Institute of Western Australia (LIWA) Westcare, and the Dust Disease Board of New South Wales, Australia. Dr Lee is a recipient of a National Health and Medical Research Council (NH&MRC) Career Development Fellowship. Dr Thomas has received research scholarship support from NH&MRC, Western Australia Cancer and Palliative Care Network (WACPCN), and LIWA, Australia.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(3):557-562. doi:10.1378/chest.13-3057
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BACKGROUND:  Indwelling pleural catheters (IPCs) are commonly used to manage malignant effusions. Tumor spread along the catheter tract remains a clinical concern for which limited data exist. We report the largest series of IPC-related catheter tract metastases (CTMs) to date, to our knowledge.

METHODS:  This is a single-center, retrospective review of IPCs inserted over a 44-month period. CTM was defined as a new, solid chest wall lesion over the IPC insertion site and/or the tunneled subcutaneous tract that was clinically compatible with a malignant tract metastasis.

RESULTS:  One hundred ten IPCs were placed in 107 patients (76.6% men; 60% with mesothelioma). CTM developed in 11 cases (10%): nine with malignant pleural mesothelioma and two with metastatic adenocarcinoma. CTM often developed late (median, 280 days; range, 56-693) post-IPC insertion. Seven cases had chest wall pain, and six received palliative radiotherapy to the CTM. Radiotherapy was well tolerated, with no major complications and causing no damage to the catheters. Longer interval after IPC insertion was the sole significant risk factor for development of CTM (OR, 2.495; 95% CI, 1.247-4.993; P = .0098) in the multivariate analyses.

CONCLUSIONS:  IPC-related CTM is uncommon but can complicate both mesothelioma and metastatic carcinomas. The duration of interval after IPC insertion is the key risk factor identified for development of CTM. Symptoms are generally mild and respond well to radiotherapy, which can be administered safely without removal of the catheter.

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