Treatment algorithms for malignancies accompanied by pleural effusion

Abstract

Pleural effusion accompanying malignant lesions of the pleura is often a marker of the spread of the tumour process. Effusion is associated with the limited opportunities of the local control and as a consequence with poor long-term results. The morphological, immunohistochemical, and molecular features of the tumour are important prognostic and predictive factors that largely determine the therapeutic tactics. Clinical guidelines in the vast majority of cases with pleural effusion indicate that the treatment goal is palliation. The main goal in these patients is to reduce symptoms and improve quality of life. Asymptomatic pleural effusion does not require treatment. Thoracentesis or symptomatic drainage provides immediate relief. With low exudate volumes and accumulation rate, rare relapses and the expected response from the systemic treatment, or, on the other hand, a short expectancy of life, it is possible to limit the management of such cases with symptomatic drainage only. In selected individuals with pleural effusion minimally invasive or surgical interventions are also recommended. These include the installation of indwelling pleural catheters, the implementation of various pleurodesis techniques. In selected subgroups, the local control can reach 87-96%. The introduction of modern surgical techniques for pleural procedures has reduced the incidence of adverse events rate to 2,7-4%. There is no doubt that it is necessary to improve algorithms and search for alternate ve solutions, including those based on combined approaches to the treatment of patients with malignant neoplastic lesions of the pleura.