Malignant pleural mesothelioma (MPM) is an aggressive, almost universally fatal cancer
with limited therapeutic options. Despite efforts, a real breakthrough in treatment
and outcomes has been elusive. Pleural effusion with significant breathlessness and
pain is the most typical presentation of individuals with MPM. Although thoracentesis
provides relief of breathlessness, most such pleural effusions recur rapidly, and
a definitive procedure is often required to prevent a recurrence. Unfortunately, the
optimal treatment modality for individuals with recurrent MPM-related effusion is
unclear, and considerable variation exists in practice. In addition, non-expandable
lung is common in pleural effusions due to MPM and makes effective palliation of symptoms
more difficult. This review delves into the latest advances in the available management
options (both surgical and non-surgical) for dealing with pleural effusion and non-expandable
lung related to MPM. We discuss factors that determine the choice of definitive procedures
that need to be tailored to the individual patient.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Asbestos-related occupational lung diseases in NSW, Australia and potential exposureof the general population.Ind Health. 2008; 46: 535-540
- Mesothelioma in Australia. 2020;
- Malignant pleural mesothelioma: an update for pulmonologists.Curr Pulmonol Rep. 2019; 8: 40-49
- Management of malignant pleural effusions.Curr Opin Pulm Med. 2020; 26: 341-345
- Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment.Eur Respir Rev. 2016; 25: 472-486
- Malignant pleural mesothelioma: recent developments.Curr Opin Oncol. 2021; 33: 80-86
- The expected burden of mesothelioma mortality in Great Britain from 2002 to 2050.Br J Cancer. 2005; 92: 587-593
- Lee Y.C.D.N. Henderson D.W. Musk A.W. Occupational disorders of the lung: recognition, management and prevention. W. B. Saunders, London2002
- Global magnitude of reported and unreported mesothelioma.Environ Health Perspect. 2011; 119: 514-518
- A novel clinical prediction model for prognosis in malignant pleural mesothelioma using decision tree analysis.J Thorac Oncol. 2016; 11: 573-582
- Predicting survival in malignant mesothelioma.Eur Respir J. 2011; 38: 1420-1424
- Comparison of outcomes following a cytological or histological diagnosis of malignant mesothelioma.Br J Cancer. 2017; 116: 703-708
- Contemporary analysis of prognostic factors in patients with unresectable malignant pleural mesothelioma.J Thorac Oncol. 2016; 11: 249-255
- MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial.BMJ Open Respir Res. 2019; 6e000368
- Review of pemetrexed in combination with cisplatin for the treatment of malignant pleural mesothelioma.Ther Clin Risk manag. 2008; 4: 205
- Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma.J Clin Oncol. 2003; 21: 2636-2644
- First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): a multicentre, randomised, open-label, phase 3 trial.Lancet. 2021; 30: 375-386
- Immunotherapy in malignant pleural mesothelioma.Front Oncol. 2020; 10: 187
- Management of pleural effusion secondary to malignant mesothelioma.J Clin Med. 2021; 10
- Occupational disorders of the lung: recognition, management and prevention.Saunders London, 2002
- Possibilities of surgical pleurodesis for malignant pleural effusion.AME Med J. 2020; 5: 20
- Management of malignant pleural effusions. An official ATS/STS/STR clinical practice guideline.Am J Respir Crit Care Med. 2018; 198: 839-849
- Group BTSPDG. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010.Thorax. 2010; 65: ii32-ii40
- Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score.Thorax. 2014; 69: 1098-1104
- Development and validation of response markers to predict survival and pleurodesis success in patients with malignant pleural effusion (PROMISE): a multicohort analysis.Lancet Oncol. 2018; 19: 930-939
- Breathlessness predicts survival in patients with malignant pleural effusions: meta-analysis of individual patient data from five randomized controlled trials.Chest. 2021; 160: 351-357
- The association between pleural fluid exposure and survival in pleural mesothelioma.Chest. 2021; 160: 1925-1933
- Outcomes and complications following medical thoracoscopy.Clin Respir J. 2012; 6: 144-149
- Mechanisms of pleurodesis.Respiration. 2012; 83: 91-98
- BTS statement on malignant mesothelioma in the UK, 2007.Thorax. 2007; 62: ii1-ii19
- Interventions for the management of malignant pleural effusions: a network meta-analysis.Cochrane Database Syst Rev. 2016; : CD010529
- Recent developments in pleurodesis for malignant pleural disease.Clin Respir J. 2018; 12: 2463-2468
- Pleurodesis outcome in malignant pleural mesothelioma.Thorax. 2013; 68: 594-596
- Effect of thoracoscopic talc poudrage vs talc slurry via chest tube on pleurodesis failure rate among patients with malignant pleural effusions: a randomized clinical trial.JAMA. 2020; 323: 60-69
- Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial.JAMA. 2012; 307: 2383-2389
- A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions.Cancer. 1999; 86: 1992-1999
- Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion: the AMPLE randomized clinical trial.JAMA. 2017; 318: 1903-1912
- Effect of opioids vs NSAIDs and larger vs smaller chest tube size on pain control and pleurodesis efficacy among patients with malignant pleural effusion: The TIME1 Randomized Clinical Trial.JAMA. 2015; 314: 2641-2653
- Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion.Chest. 2005; 127: 909-915
- Comparison of modified Borg scale and visual analog scale dyspnea scores in predicting re-intervention after drainage of malignant pleural effusion.Support Care Cancer. 2013; 21: 3109-3116
- Does oxygen help dyspnea in patients with cancer?.Am J Respir Crit Care Med. 1996; 153: 1515-1518
- Symptom management in patients with lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.Chest. 2013; 143: e455S-e497S
- A randomized controlled trial comparing indwelling pleural catheters with talc pleurodesis (NVALT-14).Lung Cancer. 2017; 108: 9-14
- Indwelling pleural catheters reduce inpatient days over pleurodesis for malignant pleural effusion.Chest. 2012; 142: 394-400
- Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial.Lancet Respir Med. 2018; 6: 671-680
- Randomized trial of pleural fluid drainage frequency in patients with malignant pleural effusions. The ASAP Trial.Am J Respir Crit Care Med. 2017; 195: 1050-1057
- Management of malignant pleural effusions using the Pleur(x) catheter.Ann Thorac Surg. 2008; 85: 1049-1055
- Management of malignant pleural effusion.J bronchology Interv Pulmonol. 2015; 22: 215-225
- Complications of indwelling pleural catheter use and their management.BMJ Open Respir Res. 2016; 3e000123
- Clinical outcomes of indwelling pleural catheter-related pleural infections: an international multicenter study.Chest. 2013; 144: 1597-1602
- Management of indwelling tunneled pleural catheters: a modified delphi consensus statement.Chest. 2020; 158: 2221-2228
- Infections associated with tunnelled indwelling pleural catheters in patients undergoing chemotherapy.J Bronchology Interv Pulmonol. 2013; 20: 299-303
- Longitudinal measurement of pleural fluid biochemistry and cytokines in malignant pleural effusions.Chest. 2016; 149: 1494-1500
- Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review.J Gen Intern Med. 2011; 26: 70-76
- Risk reduction in pleural procedures: sonography, simulation and supervision.Curr Opin Pulm Med. 2010; 16: 340-350
- Catheter tract metastasis associated with indwelling pleural catheters.Chest. 2014; 146: 557-562
- Catheter-tract metastases associated with chronic indwelling pleural catheters.Chest. 2007; 131: 1232-1234
- Prophylactic radiotherapy to intervention sites in mesothelioma: a systematic review and survey of UK practice.Lung Cancer. 2009; 66: 150-156
- Prophylactic radiotherapy for the prevention of procedure-tract metastases after surgical and large-bore pleural procedures in malignant pleural mesothelioma (SMART): a multicentre, open-label, phase 3, randomised controlled trial.Lancet Oncol. 2016; 17: 1094-1104
- Outpatient talc administration by indwelling pleural catheter for malignant effusion.N Engl J Med. 2018; 378: 1313-1322
- A novel drug-eluting indwelling pleural catheter for the management of malignant effusions.Am J Respir Crit Care Med. 2018; 197: 136-138
- Silver nitrate-coated versus standard indwelling pleural catheter for malignant effusions: the SWIFT randomized trial.Ann Am Thor Soc. 2022; 19: 1722-1729
- Management of malignant pleural effusions with indwelling pleural catheters or talc pleurodesis.Can Resp J. 2013; 20: 106-110
- Optimal management of malignant pleural effusions (results of CALGB 30102).J Natl Compr Canc Netw. 2012; 10: 975-982
- Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion: the AMPLE randomized clinical trial.JAMA. 2017; 318: 1903-1912
- Treatment of malignant pleural mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline.J Clin Oncol. 2018; 36: 1343-1373
- Does surgery improve survival of patients with malignant pleural mesothelioma? A multicenter retrospective analysis of 1365 consecutive patients.J Thorac Oncol. 2014; 9: 390-396
- The evidence on the effectiveness of management for malignant pleural effusion: a systematic review.Eur J Cardiothorac Surg. 2006; 29: 829-838
- Malignant pleural effusions and the role of talc poudrage and talc slurry: a systematic review and meta-analysis.F1000Res. 2014; 3: 254
- Pleurectomy decortication in the treatment of the “trapped lung” in benign and malignant pleural effusions.Thorac Surg Clin. 2013; 23 (vi): 51-61
- The role of video assisted thoracoscopic pleurectomy/decortication in the therapeutic management of malignant pleural mesothelioma.Eur J Cardiothorac Surg. 2008; 33: 83-88
- Improved survival with VATS pleurectomy-decortication in advanced malignant mesothelioma.Eur J Surg Oncol. 2005; 31: 314-320
- Quantitative measurement of lung reexpansion in malignant pleural mesothelioma patients undergoing pleurectomy/decortication.Acad Radiol. 2011; 18: 294-298
- The MesoVATS trial: is there a future for video-assisted thoracoscopic surgery partial pleurectomy?.Future Oncol. 2015; 11: 15-17
- Malignant pleural effusion in the presence of trapped lung. Five-year experience of PleurX tunnelled catheters.Interact Cardiovasc Thorac Surg. 2009; 9: 961-964
- Inter-observer variation in image interpretation and the prognostic importance of non-expansile lung in malignant pleural effusion.Respirology. 2020; 25: 298-304
- Manometry performed at indwelling pleural catheter insertion to predict unexpandable lung.J Thorac Dis. 2020; 12: 1374-1384
- Novel use of pleural ultrasound can identify malignant entrapped lung prior to effusion drainage.Chest. 2014; 146: 1286-1293
- Clinical utility of routine pleural manometry during therapeutic thoracentesis: a randomized trial.Lancet Respir Med. 2019; 7: 447-455
- Indwelling pleural catheters reduce inpatient days over pleurodesis for malignant pleural effusion.Chest. 2012; 142: 394-400
- The Pleural Effusion And Symptom Evaluation (PLEASE) study of breathlessness in patients with a symptomatic pleural effusion.Eur Respir J. 2020; 55
- ERS/EACTS statement on the management of malignant pleural effusions.Eur Respir J. 2018; 52
- ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma.Eur Respir J. 2020; 55
Article info
Publication history
Published online: March 14, 2023
Accepted:
February 8,
2023
Received in revised form:
January 29,
2023
Received:
September 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
