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To Seed or Not to SeedMesothelioma Catheter Tract Seeding: The Open Question of Mesothelioma Intervention Tract Metastases FREE TO VIEW

Luca Bertolaccini, MD, PhD, FCCP; Andrea Viti, MD; Alberto Terzi, MD
Author and Funding Information

From the Thoracic Surgery Unit (Drs Bertolaccini and Viti), S Croce e Carle Teaching Hospital; and Thoracic Surgery Unit (Dr Terzi), Sacred Heart Research Hospital.

CORRESPONDENCE TO: Luca Bertolaccini, MD, PhD, FCCP, Thoracic Surgery Unit, S Croce e Carle Teaching Hospital, Via Michele Coppino, 26-12100 Cuneo, Italy; e-mail: luca.bertolaccini@gmail.com


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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):e111. doi:10.1378/chest.14-0822
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To the Editor:

Catheter tract seeding is a common complication of diagnostic and therapeutic procedures for mesothelioma pleural effusion1; however, there are few reports about catheter tract metastasis (CTM) complicating indwelling pleural catheter (IPC) insertion. The largest series to date is a pooled systematic review of 10 studies involving 1,093 patients, with evidence of catheter tract seeding in nine patients (0.8%).2 In our study, we found no cases of CTM in 13 of 90 patients with mesothelioma pleural effusions treated with IPC placement.3 Nevertheless, the currently available literature is limited by a lack of information about histologic subtype, disease stage, and treatment or diagnostic procedure.

In this issue of CHEST (see page 557), Thomas et al4 reported that IPCs were positioned predominantly for mesothelioma-related pleural effusion (60%) and that 10% of patients subsequently developed CTM (nine patients with mesothelioma of the 11 with IPC tract seeding). The patients with CTM were referred for radiotherapy; six completed therapy, but only four had a clinical response.

The benefit of prophylactic tract irradiation in patients with mesothelioma remains controversial. The two randomized clinical trials had small sample sizes with inadequate statistical power. Large-scale prospective studies are virtually impossible to perform because of the relatively low incidence of mesothelioma. On the basis of the existing trials, prophylactic irradiation of the intervention tract is not currently justified.5 Prophylactic irradiation of the intervention tract has not been tested so far in patients with IPC, however.

In brief, a well-known characteristic of mesothelioma is tract metastasis after thoracentesis or thoracoscopy, and evidence for the possible benefit of prophylactic radiotherapy is lacking. Therefore, prophylactic irradiation of the intervention site will need to be tested to determine whether it can reduce or prevent tract colonization in patients with an IPC.

References

Agarwal PP, Seely JM, Matzinger FR, et al. Pleural mesothelioma: sensitivity and incidence of needle track seeding after image-guided biopsy versus surgical biopsy. Radiology. 2006;241(2):589-594. [CrossRef] [PubMed]
 
Van Meter ME, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med. 2011;26(1):70-76. [CrossRef] [PubMed]
 
Bertolaccini L, Viti A, Gorla A, Terzi A. Home-management of malignant pleural effusion with an indwelling pleural catheter: ten years experience. Eur J Surg Oncol. 2012;38(12):1161-1164. [CrossRef] [PubMed]
 
Thomas R, Budgeon CA, Kuok YJ, et al. Catheter tract metastasis associated with indwelling pleural catheters. Chest. 2014;146(3):557-562.
 
Nagendran M, Pallis A, Patel K, Scarci M. Should all patients who have mesothelioma diagnosed by video-assisted thoracoscopic surgery have their intervention sites irradiated? Interact Cardiovasc Thorac Surg. 2011;13(1):66-69. [CrossRef] [PubMed]
 

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References

Agarwal PP, Seely JM, Matzinger FR, et al. Pleural mesothelioma: sensitivity and incidence of needle track seeding after image-guided biopsy versus surgical biopsy. Radiology. 2006;241(2):589-594. [CrossRef] [PubMed]
 
Van Meter ME, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med. 2011;26(1):70-76. [CrossRef] [PubMed]
 
Bertolaccini L, Viti A, Gorla A, Terzi A. Home-management of malignant pleural effusion with an indwelling pleural catheter: ten years experience. Eur J Surg Oncol. 2012;38(12):1161-1164. [CrossRef] [PubMed]
 
Thomas R, Budgeon CA, Kuok YJ, et al. Catheter tract metastasis associated with indwelling pleural catheters. Chest. 2014;146(3):557-562.
 
Nagendran M, Pallis A, Patel K, Scarci M. Should all patients who have mesothelioma diagnosed by video-assisted thoracoscopic surgery have their intervention sites irradiated? Interact Cardiovasc Thorac Surg. 2011;13(1):66-69. [CrossRef] [PubMed]
 
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