EL12 - Malignant Pleural and Peritoneal Carcinomatosis Treatment

Abstract

ABSTRACT Malignant pleural and peritoneal carcinomatosis is a potential complication of various types of cancer, the most common of which is lung cancer (accounting for ∼35%), followed by breast cancer, lymphoma, ovarian, and gastrointestinal cancers. Although malignant pleural effusion represents end-stage incurable disease, when symptomatic, they can have a significant effect on quality of life and should be treated. Pleural and peritoneal effusion is considered malignant only when the cytology is positive for malignant cells; in fact, 25% of effusions associated with malignancies may have a negative cytology, which can be misleading. Malignant pleural effusions associated with some malignancies may be responsive to systemic therapy and do not require pleurodesis. Effusions developed during small-cell lung cancer, breast cancer, and lymphoma may respond to systemic therapy and only require occasional therapeutic thoracentesis. However, patients in whom effusion cannot be resolved with systemic therapy should be quickly treated by pleurodesis to minimize the possibility of trapped lung syndrome. While pleurodesis is frequently used in the management of malignant pleural effusion, the optimal strategy remains undefined. Pleurodesis can be carried out in a variety of ways, including instillation of a sclerosing agent such as OK-432, talc, bleomycin, or doxycycline, mechanical pleurodesis, and pleurectomy. In the case of malignant peritoneal effusion, systemic chemotherapy should be used for control of the primary tumor as well as intraperitoneal administration of chemotherapeutic agents. However, no consensus has thus far been reached on the management of this complication other than in ovarian cancer. In this educational seminar, the treatment strategy for managing malignant pleural and peritoneal effusion will be discussed.