Disorders of the Pleura |

Malignant Pleural Effusions, Can We Predict Time to Recurrence? FREE TO VIEW

Khizer Shaikh, MD; Mohit Chawla, MD; Diane Stover, MD; Robert Lee, MD
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Memorial Sloan Kettering Cancer Center, New York, NY

Chest. 2015;148(4_MeetingAbstracts):437A. doi:10.1378/chest.2278333
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SESSION TITLE: Disorders of the Pleura Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The time to recurrence of a malignant pleural effusion stratified by cancer type is not well defined and often results in patients presenting to an emergency department or being admitted for symptomatic emergent drainage prior to their outpatient follow up. The purpose of this study is to retrospectively evaluate the clinical course of patients who have undergone serial pleural procedures for symptomatic relief with the objective of identifying factors/predictors that would determine a more effective future management algorithm.

METHODS: Retrospective study evaluating 180 patients with cancer who presented to a large multi-specialty cancer center for the first time with a symptomatic, unilateral and undiagnosed pleural effusion. Patients were followed until their death or last date of follow up. Baseline characteristics included age, gender, cancer type, chemotherapy status (active/prior/never) and effusion size. Pleural fluid characteristics, the date of each serial pleural procedure and procedure type were recorded for each patient.

RESULTS: 180 patients were evaluated (348 pleural procedures). 17/180 (9%) were transudative effusions and 163/180 (91%) were exudative, based on Light’s criteria. Of the exudative effusions, 81/163 (50%) were cytology positive or suspicious for malignancy. 18 patients received a tunneled pleural catheter (TPC) and 6 patients required a pigtail catheter on initial presentation. Of the 162 patients who underwent an initial thoracentesis, 96 (60%) presented with recurrence within an average of 48 days from initial presentation. 46/96 (48%) patients required a third procedure within 67 days of their second presentation. 16/46 (34%) patients required a fourth procedure within 32 days of their third presentation. TPC placement was performed in 87/180 (48%) patients, 25 patients achieved spontaneous pleurodesis. Of the patients who acheived pleurodesis, 4 patients (16%) required a subsequent thoracentesis, for recurrence of pleural effusion. Median survival from initial presentation was 193 days.

CONCLUSIONS: Malignant pleural effusions have a high rate of recurrence resulting often in unplanned ED/inpatient visits requiring emergent drainage. Given their high frequency of recurrence, TPC placement should be considered early in the clinical course of cancer patients in whom palliation of symptoms is of utmost importance.

CLINICAL IMPLICATIONS: Management of recurrent malignant pleural effusions.

DISCLOSURE: The following authors have nothing to disclose: Khizer Shaikh, Mohit Chawla, Diane Stover, Robert Lee

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