Recurrence Of Malignant Pleural Effusion Research Articles

Complete response and long-term survival to endocrine monotherapy in a patient with metastatic breast cancer in a low-income country: a case report

BackgroundBreast cancer is the most common cancer in women. Progression-free survival for hormone receptor-positive/human epidermal growth factor receptor-2-negative metastatic breast cancer treated with endocrine therapy in combination with cyclin4/6-dependent kinase is approximately 25 months. This case represents metastatic breast cancer treated with endocrine therapy, leading to long-term survival.Case presentationA 40-year-old Syrian woman diagnosed with hormone receptor-negative breast cancer was treated surgically with adjuvant chemotherapy and radiotherapy. She developed local and nodal recurrences that were hormone receptor-positive, followed by a recurrence of malignant pleural effusion. She was initially treated with chemotherapy and then placed on endocrine therapy with a complete response from 2014 until now. The patient also suffered from adverse events of medications, such as heart failure and osteoporosis, which were treated appropriately.ConclusionThis case demonstrates a long-lasting complete response to metastatic breast cancer with malignant pleural effusion. This shows the validity of endocrine therapy in recurrent hormone receptor-positive breast cancer, especially in countries that cannot afford targeted therapies or genetic tests. It also highlights the necessity for a better understanding of the prognostic and predictive factors.

Single-cell transcriptomics reveal metastatic CLDN4+ cancer cells underlying the recurrence of malignant pleural effusion in patients with advanced non-small-cell lung cancer.

Recurrent malignant pleural effusion (MPE) resulting from non-small-cell lung cancer (NSCLC) is easily refractory to conventional therapeutics and lacks predictive markers. The cellular or genetic signatures of recurrent MPE still remain largely uncertain. 16 NSCLC patients with pleural effusions were recruited, followed by corresponding treatments based on primary tumours. Non-recurrent or recurrent MPE was determined after 3-6 weeks of treatments. The status of MPE was verified by computer tomography (CT) and cytopathology, and the baseline pleural fluids were collected for single-cell RNA sequencing (scRNA-seq). Samples were then integrated and profiled. Cellular communications and trajectories were inferred by bioinformatic algorithms. Comparative analysis was conducted and the results were further validated by quantitative polymerase chain reaction (qPCR) in a larger MPE cohort from the authors' centre (n=64). The scRNA-seq revealed that 33590 cells were annotated as 7 major cell types and further characterized into 14 cell clusters precisely. The cell cluster C1, classified as Epithelial Cell Adhesion Molecule (EpCAM)+ metastatic cancer cell and correlated with activation of tight junction and adherence junction, was significantly enriched in the recurrent MPE group, in which Claudin-4 (CLDN4) was identified. The subset cell cluster C3 of C1, which was enriched in recurrent MPE and demonstrated a phenotype of ameboidal-type cell migration, also showed a markedly higher expression of CLDN4. Meanwhile, the expression of CLDN4 was positively correlated with E74 Like ETS Transcription Factor 3 (ELF3), EpCAM and Tumour Associated Calcium Signal Transducer 2 (TACSTD2), independent of driver-gene status. CLDN4 was also found to be associated with the expression of Hypoxia Inducible Factor 1 Subunit Alpha (HIF1A) and Vascular Endothelial Growth Factor A (VEGFA), and the cell cluster C1 was the major mediator in cellular communication of VEGFA signalling. In the extensive MPE cohort, a notably increased expression of CLDN4 in cells from pleural effusion among patients diagnosed with recurrent MPE was observed, compared with the non-recurrent group, which was also associated with a trend towards worse overall survival (OS). CLDN4 could be considered as a predictive marker of recurrent MPE among patients with advanced NSCLC. Further validation for its clinical value in cohorts with larger sample size and in-depth mechanism studies on its biological function are warranted. Not applicable.

221P Single-cell transcriptomics reveals CLDN4+ cancer cells underlying the recurrence of malignant pleural effusion in patients with advanced non-small cell lung cancer

221P Single-cell transcriptomics reveals CLDN4+ cancer cells underlying the recurrence of malignant pleural effusion in patients with advanced non-small cell lung cancer

Risk factors for symptomatic malignant pleural effusion recurrence in patients with actionable mutations in advanced lung adenocarcinoma.

Malignant pleural effusion (MPE) comes generally with high mortality and poor prognosis. Recurrence of symptomatic MPE is always accompanied by poor survival quality. In lung adenocarcinoma, researchers speculate whether patients with actionable mutation or without are applicable to different management models for MPE. Under the background of the high mutation probability and the encouraging therapeutic response in Asians, researches on the risk factors of MPE are in need. This retrospective review included 343 metastatic lung adenocarcinoma patients with MPE. Recurrence was defined as recurrent symptomatic MPE requiring the second thoracentesis to relieve symptoms within 300 days after the first thoracentesis. Univariable and multivariable Cox regression analysis were utilized to investigate independent risk factors for MPE recurrence. Of the 343 patients involved, 139 experienced MPE recurrence within 300 days; 34.3% in 201 patients with actionable mutations and 51.2% in 129 patients without actionable mutations are in the recurrence. The median recurrence-free survival (RFS) of the group without mutations was 161 days. The median RFS of the other group with mutations was 300 days. Patients with actionable mutations showed a significantly lower hazard of MPE recurrence on univariate analysis. The multivariate analysis indicated that receiving targeted therapy after the first thoracentesis within 30 days, lower neutrophil-to-lymphocyte ratio (NLR) level, lower serum lactate dehydrogenase (s-LDH) level, and lower serum carcinoembryonic antigen (s-CEA) level were independent protective factors. In subgroup analysis, risk factors differed. Receiving targeted therapy after the first thoracentesis within 30 days remained an independent factor in the mutated patients. The findings herein indicated the characteristics of specific patients at high risk for MPE recurrence in lung adenocarcinoma. Patients with actionable mutations benefit more in MPE recurrence and could benefit from targeted therapy and active intrapleural management.

Which is the More Effective Option for Pleurodesis to Prevent the Recurrence of Malignant Pleural Effusion? Large-Particle Talc or Mistletoe Extract (ABNOVA Viscum Injection).

Malignant pleural effusion affects many patients with advanced cancer. When chemotherapy or radiotherapy fails to relieve malignant pleural effusion and related symptoms, drainage and pleurodesis can help. Although surgical talc pleurodesis is the most widely used method, Viscum album, which has been recently used in surgical or bedside procedures, has demonstrated significant results and is as effective as talc. This study aimed to determine the most effective agent and procedure. Between January 2015 and July 2022, chemical pleurodesis was performed in 137 patients with malignant pleural effusion, using a V. album surgical procedure in 48, a V. album bedside procedure in 55, and a talc surgical procedure in 34 patients. We reviewed patients' clinical responses and disease progression after chemical pleurodesis. The success rate was not significantly different among the V. album surgical procedures (91.7%), V. album bedside procedures (83.6%), and talc surgical procedures (91.2%). However, the total drainage amount and tube insertion duration in both Viscum groups were more effective than those in the talc group. Furthermore, the bedside Viscum group showed significantly lower post-pleurodesis pain scores than the other 2 groups. According to our results, talc and V. album can be considered ideal agents for chemical pleurodesis. However, Viscum pleurodesis showed safer outcomes in terms of ensuring quality of life than talc. Additionally, the bedside Viscum group showed significantly lower pain scores than the other groups. Hence, patients for whom surgical procedures are inappropriate can undergo bedside Viscum pleurodesis without diminishing the therapeutic effect.

Failure pattern and radiotherapy exploration in malignant pleural effusion non-small cell lung cancer treated with targeted therapy.

Actionable mutations are common in non-small cell lung cancer(NSCLC)with malignant pleural effusion(MPE)(MPE-NSCLC). The pattern of failure in MPE-NSCLC treated with targeted therapy after MPE control remains unclear. We aimed to investigate the failure pattern of such patients in a cohort study and explore the possibility of radiotherapy. Computed tomography scans of 86 patients were reviewed in this study. We classified first pattern of failure after MPE control as initial disease sites only (IF), new distant sites only (NF), or IF and NF detected simultaneously (INF). Patients evaluated suitable for radiotherapy after disease progression were divided into two groups: D group without radiotherapy and RD group with radiotherapy. The Kaplan-Meier method and log-rank test were used for survival analyses. Disease progression after MPE control was observed in 42 patients with complete serial imaging. Median time to any progression was 9.5 months. Rate of the IF, NF and INF were 50%, 17% and 33% for all patients,60%,0% and 40% for patients with MPE recurrence (n=10,23.8%) and 47%, 22% and 31% for patients (n=32,76.2%) without MPE recurrence, respectively. Out of 10 patients(23.8%) with MPE recurrence, 7 patients simultaneous underwent primary tumor progression and 5 MPE were cytologically confirmed in 7 patients with examination. The overall survival (OS )rates at 1, 2, 3 years for the RD group and D group were 88.2%, 50.5%, 21.7% and 80.0%, 20.3%, 0%, respectively; the corresponding MST were 26.1 months and 17.5 months, respectively (χ2 = 4.959, p =0.026). Our data indicates that 50% of patients with actionable mutations MPE- NSCLC after MPE control are likely to fail at their initial sites of disease and the use of radiotherapy may bring OS benefits during the course of their disease. Multicenter RCT is necessary to confirm the result in the future.

Efficacy and safety of endostar combined with cisplatin in treatment of non-small cell lung cancer with malignant pleural effusion: A meta-analysis

Although there are new treatments for non-small cell lung cancer with malignant pleural effusion, these therapies are prone to recurrent pleural effusion and poor in efficacy. And recombinant human endostatin is a new type of anti-tumor angiogenesis drug independently developed in my country. It has the effect of inhibiting tumor angiogenesis, inhibiting tumor proliferation and differentiation, and effectively inhibiting the formation and recurrence of malignant pleural effusion. Therefore, this study is aim to systematically review the efficacy and safety of intrapleural injection of endostar combined with cisplatin in the treatment of non-small cell lung cancer (NSCLC) with malignant pleural effusion. Databases including Cochrane Library, PubMed, CBM, Embase, CNKI, and WanFang Data were searched to collect randomized controlled trials about endostar combined with cisplatin for NSCLC with malignant pleural effusion from inception to April 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Finally, the meta-analysis was made by using RevMan 5.4.1 software. A total of 11 randomized controlled trials involving 814 patients were finally included. The results of the meta-analysis showed that: The overall response rate and the improvement rate of quality of life in the endostar combined with cisplatin group were higher than that of the cisplatin alone group (relative risk = 1.58, 95% confidence interval = 1.42-1.76, P < .00001; relative risk = 1.63, 95% confidence interval = 1.38-1.93, P < .00001, respectively). Meanwhile, there were no significant differences between the 2 groups in the incidence of gastrointestinal reaction, the incidence of leucopenia, the incidence of thrombocytopenia, and the incidence of hypodynamia (all P values > .05). Compared with cisplatin, intrapleural injection of endostar combined with cisplatin could improve the overall response rate and the quality of life of NSCLC patients with malignant pleural effusion. Due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusion.

Risk Factors for and Time to Recurrence of Symptomatic Malignant Pleural Effusion in Patients With Metastatic Non-Small Cell Lung Cancer with EGFR or ALK Mutations

The main goal of management in patients with non-small cell lung cancer (NSCLC) and malignant pleural effusion (MPE) is palliation. Patients with MPE and actionable mutations, because their disease is expected to respond quickly and markedly to targeted therapy, are less likely than those without actionable mutations to receive definitive MPE management. Whether such management is indicated in these patients is unclear. What is the time to ipsilateral MPE recurrence requiring intervention in patients with metastatic NSCLC by mutation status? What are the risk factors for MPE recurrence? Retrospective cohort study of consecutive patients who underwent initial thoracentesis for MPE. We used a Fine-Gray subdistribution hazard model to calculate the time to ipsilateral MPE recurrence requiring intervention within 100days of initial thoracentesis and to identify variables associated with time to pleural fluid recurrence. A total of 396 patients, comprising 295 (74.5%) without and 101 (25.5%) with actionable mutations, were included. Most patients with actionable mutations (90%) were receiving targeted treatment within 30days of initial thoracentesis. On univariate analysis, patients with actionable mutations showed a significantly higher hazard of MPE recurrence. On multivariate analysis, this difference was not significant. Larger pleural effusion size on chest radiography (P< .001), higher pleural fluid lactate dehydrogenase (P< .001), and positive cytologic examination results (P= .008) were associated with an increased hazard of recurrence. Our findings indicate that patients with actionable mutations have a similar risk of MPE recurrence when compared with patients without mutations and would benefit from a similar definitive management approach to MPE.

Using creative co-design to develop a decision support tool for people with malignant pleural effusion

BackgroundMalignant pleural effusion (MPE) is a common, serious problem predominantly seen in metastatic lung and breast cancer and malignant pleural mesothelioma. Recurrence of malignant pleural effusion is common, and symptoms significantly impair people’s daily lives. Numerous treatment options exist, yet choosing the most suitable depends on many factors and making decisions can be challenging in pressured, time-sensitive clinical environments. Clinicians identified a need to develop a decision support tool. This paper reports the process of co-producing an initial prototype tool.MethodsCreative co-design methods were used. Three pleural teams from three disparate clinical sites in the UK were involved. To overcome the geographical distance between sites and the ill-health of service users, novel distributed methods of creative co-design were used. Local workshops were designed and structured, including video clips of activities. These were run on each site with clinicians, patients and carers. A joint national workshop was then conducted with representatives from all stakeholder groups to consider the findings and outputs from local meetings.The design team worked with participants to develop outputs, including patient timelines and personas. These were used as the basis to develop and test prototype ideas.ResultsKey messages from the workshops informed prototype development. These messages were as follows. Understanding and managing the pleural effusion was the priority for patients, not their overall cancer journey. Preferred methods for receiving information were varied but visual and graphic approaches were favoured. The main influences on people’s decisions about their MPE treatment were personal aspects of their lives, for example, how active they are, what support they have at home.The findings informed the development of a first prototype/service visualisation (a video representing a web-based support tool) to help people identify personal priorities and to guide shared treatment decisions.ConclusionThe creative design methods and distributed model used in this project overcame many of the barriers to traditional co-production methods such as power, language and time. They allowed specialist pleural teams and service users to work together to create a patient-facing decision support tool owned by those who will use it and ready for implementation and evaluation.

Comparison of Talc Pleurodesis versus Bleomycin in Malignant Pleural Effusion

Back ground: Malignant pleural effusion can cause significant morbidity to terminal patients. Drainage and control pleural effusion can provide great palliation and improve the quality of life of these patients. The purpose of this study was to evaluate which agent, bleomycin or talc pouring for pleurodesis is superior in terms of effectiveness, safety and cost.&#x0D; Methods: It is a prospective randomized clinical trial from January 2013 to December 2014. A series of 38 patients entered in this trial. Inclusion criteria was diagnosed case of malignant pleural effusion either by fluid cytology or by pleural biopsy. Exclusion criteria was trapped lung, loculated effusions and life expectancy &lt;1 month. Five grams of talc in 50ml of normal saline or 1 unit per kg body weight of bleomycin mixed in 50 ml of normal saline, was administered via chest tube thoracostomy after minimum drainage &lt;100 ml daily in each patient. Treatment success was defined as the absence of recurrent pleural effusion on the chest radiography 1 month after pleurodesis.&#x0D; Results: Treatment success was achieved in 16 out of 18 patients (89%) in talc slurring group versus 14 out of 20 patients (70%) in the bleomycin group (p=0.154). Fever, pain and hypersensitivity were the side effects of pleurodesis.&#x0D; Conclusions: These results reflect that talc use was more effective than bleomycin in preventing early recurrence of malignant pleural effusions. Pleurodesis with talc instate of bleomycin can result in significant cost effective.&#x0D; J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 42-48

Prognostic factors of recurrence of malignant pleural effusion: what is the role of neoplasia progression?

BackgroundIt is known that malignant pleural effusion (MPE) recurs rapidly, in a considerable number of patients. However, some patients do not have MPE recurrence. Since MPE is associated with an average survival of 4–7 months, accurate prediction of prognosis may help recognize patients at higher risk of pleural recurrence, aiming to individualize more intensive treatment strategies.MethodsA prospectively assembled database of cases with pleural effusion treated at a single institution analyzed a subset of patients with symptomatic MPE. Prognostic factors for pleural recurrence were identified by univariable analysis using Kaplan-Meier method and the log-rank test was used for the comparison between the curves. Univariate and multiple Cox regression models were used to evaluate the risk (HR) of recurrence. Receiver operating characteristics (ROC) analysis determined the cutoff points for continuous variables.ResultsA total of 288 patients were included in the analysis. Recurrence-free survival was of 76.6% at 6 months and 73.3% at 12 months. Univariable analysis regarding factors affecting postoperative recurrence was: lymphocytes, platelets, pleural procedure, chemotherapy lines and number of metastases. The independent factors for recurrence-free survival were pleural procedure and chemotherapy lines. Patients who were submitted to pleurodesis had a protective factor for recurrence, with an HR =0.34 (95% CI, 0.15–0.74, P=0.007). On the other hand, patients submitted to the 1st and 2nd line of palliative CT had, respectively, an HR risk = 2.81 (95% CI, 1.10–7.28, P=0.034) and HR =3.23 (95% CI, 1.33–7.84, P=0.010).Conclusionspatients receiving the first or second line of systemic treatment have a higher risk of MPE recurrence when compared to patients who underwent MPE treatment before starting the systemic treatment. The definitive treatment of MPE, such as pleurodesis, was associated with a lower risk of MPE recurrence.

P1.16-18 Pleural Malignant Effusion. Is it Possible to Predict Recurrence After Palliative Pleural Procedure?

Malignant pleural effusion (MPE) accounts for several hospital admissions. MPE recurs rapidly in a considerable number of patients. Since MPE is associated with poor survival, a detailed prognosis may help to recognize patients with at higher risk of recurrence, aiming to individualize treatment strategies. However, there have been few studies that evaluated factors, including systemic therapy, associated with MPE recurrence. The aim of this study was to recognize risk factors of recurrence in symptomatic patients only, who required a pleural approach. A prospectively assembled database was analyzed to search for patients with symptomatic MPE. The obtained data included basic demographics, primary tumor site, performance status, neutrophil/lymphocyte ratio (NLR) and platelets/lymphocyte ratio. Metastatic sites were also evaluated, which was defined as presence of any numbers of metastasis at each organ. Regarding the postoperative period, we analyzed pleural effusion recurrence, the palliative approach used, in addition to the biochemical profile of pleural fluid. Pleural thickening and pulmonary infiltrate were also described. Systemic treatment was evaluated. Patients were classified into three groups at MPE diagnosis: systemic treatment-naïve patients, patients who received first-line systemic treatment and patients receiving second-line systemic treatment or further therapy. The quantitative variables without definite cutoff points were submitted to the ROC (Receiver Operating Characteristic) curve, using a sub-sample of 50% of the recorded cases. Cutoff points were defined as the ones with sensitivity and specificity values >0.80. Univariate and multiple Cox regression models were used to evaluate the risk of recurrence (HR) and their respective 95% confidence intervals (95%CI). Of the 288 analyzed patients, the most frequent main procedure was pleurodesis (43.1%). Disease recurrence occurred in 58 patients (20.1%). Recurrence-free survival was 73.3% at 12 months. Patients submitted to the pleurodesis procedure had a longer recurrence-free survival of 84.6%, with HR = 0.33 (95%CI = 0.17 - 0.63) when compared to patients who underwent the pleural drainage. Regarding the chemotherapy lines of treatment, Cox univariate analysis showed that the risk of recurrence for those submitted to the 1st line of palliative CT was HR = 3.19 (95% CI = 1.32 - 7.70) and for the 2nd line of palliative CT, HR = 7.32 (95% CI = 3.34 - 16.07) when compared to the systemic treatment-naïve patients. The independent factors for recurrence-free survival were procedure and chemotherapy lines. Patients who were submitted to pleurodesis had a protective factor for recurrence, with an HR = 0.34 (95% CI = 0.15 - 0.74, p = 0.007). On the other hand, patients submitted to the 1st and 2nd line of palliative CT had, respectively, an HR risk = 2.81 (95% CI = 1.10-7.28, p = 0.034) and HR = 3.23 (95% CI = 1.33 - 7.84, p = 0.010). Patients receiving the first or second line of systemic treatment have a higher risk of MPE recurrence when compared to patients who underwent MPE treatment before starting the systemic treatment. The definitive treatment of MPE, such as pleurodesis, was associated with a lower risk of MPE recurrence.

Pre-EDIT: A Randomized Feasibility Trial of Elastance-Directed Intrapleural Catheter or Talc Pleurodesis in Malignant Pleural Effusion

Talc slurry pleurodesis (TSP) prevents recurrence of symptomatic malignant pleural effusion (MPE) in 71%to 78%patients. Nonexpansile lung (NEL) frequently accounts for TSP failure but is often occult predrainage, impairing selection of patients. NEL is associated with high pleural elastance (PEL), but technical limitations have hampered the development of PEL as a predictive NEL marker. We performed a single-center, randomized, controlled, open-label feasibility trial of EDIT (elastance-directed indwelling pleural catheter or TSP) management, using a novel digital manometer and a new definition of high PEL. Patients with symptomatic MPE were randomized 1:1 between EDIT and standard care (TSP). EDIT involved PEL assessment during large-volume thoracentesis; patients with high PEL (maximum PEL sustained over 250mL [MaxPEL250]≥ 14.5cm H2O/L) were allocated to immediately receive an indwelling pleural catheter; the remainder underwent immediate drain placement for TSP. The primary outcome measure was recruitment feasibility, defined a priori as 30 patients over 12months. Secondary outcomes included safety, technical reliability, and the aspiration volume required to detect high PEL. The accuracy of the PEL definition for NEL was analyzed post hoc. Thirty-one patients were randomized (one allocation failure) over 12months. PEL assessment (mean duration, 33 minutes) was successful in 13 of 15 patients (87%). No directly attributable serious adverse events occurred. High PEL was detected in seven of 13 patients (54%), associated with 100%sensitivity and 67%specificity for NEL, and was first detected at a median volume of 325mL (range, 250-800mL). A phase 3 trial testing the effect of EDIT management on symptomatic MPE recurrence following TSP is feasible. ClinicalTrials.gov; No.: NCT03319186; URL: www.clinicaltrials.gov.

P3.15-14 Using Creative Co-Production to Develop a Treatment Decision Support Tool for People with Malignant Pleural Effusion

Malignant pleural effusion (MPE) is a common, serious problem predominantly seen in metastatic lung and breast cancer and malignant pleural mesothelioma (MPM). Recurrence of MPE is common, and symptoms significantly impact on people’s daily lives. No ideal treatment strategy for MPE currently exists. However, there are four main treatment options aimed at relieving symptoms and improving quality of life. These include aspiration, thoracoscopy with pleurodesis, bedside pleurodesis and indwelling pleural catheter. Choosing which option is best depends on many factors and making decisions can be challenging in pressured clinical environments. This project aimed to develop a support tool to help this decision making process for people with MPE. Pleural teams from three sites in the UK undertook a creative co-production (CC-P) approach led by the translating knowledge into action (TK2A) team of the NIHR Research Collaboration and Leadership in Applied Health Research and Care Yorkshire and Humber. The geographical distance between the three sites and the ill-health of service users meant a novel distributed model of CC-P was used. This comprised of three locally run workshops with clinicians, patients and carers that were designed and structured by the TK2A CC-P experts. This was followed by a joint national workshop with representatives from all stakeholder groups to consider findings and outputs from local meetings. The design team worked with participants to develop outputs including patient timelines and personas. These were used as the basis to develop and test visible and tangible prototype ideas. Some key messages emerged that informed prototype development. Understanding and managing their pleural effusion was the priority for patients, not their overall cancer journey. Preferred methods for receiving information were varied but visual and graphic approaches were favoured. The main influences on people’s decisions about their MPE treatment were personal aspects of their lives (e.g. how active they are, what support they have at home). The design team developed a first prototype (i.e. a video representing a web-based support tool) to help people identify personal priorities and guide shared treatment decisions. This requires further development before implementation into practice. The creative design methods and distributed model of co-production used in this project overcame many of the barriers to traditional co-production methods such as power, language and time. They allowed specialist pleural teams and service users to work together to create a patient-facing decision support tool owned by those who will use it.

Efficacy and safety of Viscum album extract (Helixor-M) to treat malignant pleural effusion in patients with lung cancer

Manifestations of malignant pleural effusions (MPEs) are alleviated by local therapies as well as by systemic treatment. After 2009, when commercial use of talc was discontinued in Korea, we have used Helixor-M, which is derived from the European mistletoe (Viscum album), as an alternative sclerosing agent for pleurodesis. We aimed to evaluate the efficacy and safety of Helixor-M for controlling MPE. Between 2009 and 2015, we consecutively enrolled 52 patients with lung cancer, who underwent pleurodesis to treat MPE and were analyzed retrospectively. On day 1, 100mg of Helixor-M was instilled via pleural catheter. If the procedure was not effective, it was repeated every other day up to five times, and the dose increased each time by 100mg. The primary study outcome was reappearance of pleural effusion at 1month after the last pleurodesis procedure. The median age of patient was 63years, and 77% of the 52 patients were male. About 85% of pleural effusions were found to be malignant by cytogenetic analysis. Forty-two (81%) patients were evaluable for recurrence of MPE. The 1-month recurrence rate was 48% (20/42). Among the 20 patients who developed recurrent MPE, 6 required therapeutic thoracentesis. Thirteen (25%) patients experienced procedure-related pain requiring medication. Eight (15%) had fever > 38°C. Our results suggest that a pleurodesis with Helixor-M was an effective and tolerable procedure for controlling MPE in lung cancer patients.

Conventional versus pigtail chest tube-are they similar for treatment of malignant pleural effusions?

The optimal chest tube type and size for drainage and chemical pleurodesis of malignant pleural effusions remains controversial. This retrospective study was conducted to compare the efficacy of conventional versus pigtail chest tube in the treatment of malignant pleural effusions. Patients submitted to chest tube drainage and slurry talc pleurodesis due to malignant pleural effusion in our pulmonology ward from 2012 to 2016 were eligible. According to the type of chest tube, they were divided into two groups: group I-conventional chest tube and group II-pigtail chest tube. Number of deaths, recurrence of malignant pleural effusion, and timelines associated with the procedures were reviewed and compared between groups. Out of the 61 included patients, 46 (75.4%) were included in group I and 15 (24.6%) in group II. Only one patient had pigtail chest tube obstruction, with posterior insertion of conventional chest tube. Death during hospital stay and up to 3months, recurrence at 4weeks, total duration of hospital stay, time from chest tube insertion to pleurodesis, and time from chest tube insertion to removal were not significantly different between the two groups (all p > 0.05). These findings suggest that pigtail chest tube can be an alternative on palliation, with no compromise in pleurodesis performance.

P2.10-006 Prognostic Factors of Mortality and Recurrence of Malignant Pleural Effusion in High-Risk Tumors According to the LENT Score Study

P2.10-006 Prognostic Factors of Mortality and Recurrence of Malignant Pleural Effusion in High-Risk Tumors According to the LENT Score Study

Comparison of Practice Patterns and Outcomes for Recurrent Malignant Pleural Effusions

SESSION TITLE: Pleural Effusions SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 29, 2017 at 07:30 AM - 08:30 AM PURPOSE: Guidelines for treatment of recurrent malignant pleural effusions (MPE) recommend use of definitive procedures, such as indwelling pleural catheters (IPC) or pleurodesis, over repeat thoracentesis. However, there is a paucity of comparative effectiveness data assessing the impact of practice patterns on outcomes. We hypothesized that many patients receive multiple thoracenteses rather than receiving a definitive procedure as per guidelines and that guideline inconsistent care would result in more pleural procedures and complications. METHODS: Design: Retrospective cohort study of SEER-Medicare data from 2007-2011. The primary outcome was whether patients with rapidly recurring MPE, defined as recurrence within 2 weeks of their first thoracentesis, received guideline consistent care. Secondary outcomes included subsequent pleural procedures, pneumothorax from pleural procedures, location of care, and inpatient days associated with pleural procedures. Setting: Community and academic practices. Participants: Patients age 66-90 diagnosed with their first primary cancer with a MPE that had a thoracentesis were identified using ICD-9 and CPT codes. Thoracentesis for MPE was performed in 23,431 patients. Of these 12,967 (55%) required a second pleural procedure, 8,572 (37%) died without another pleural procedure and 1,892 (8%) were alive without recurrence at last follow-up. Of the 12,967 patients that required a second pleural procedure, 7,565 (58%) had it within 14 days of the first procedure. Exposure variable: Guideline consistent care, defined as a definitive second pleural procedure. RESULTS: Of the 7,565 patients with rapidly recurring MPE’s, only 1,811 (24%) received guideline consistent care. Definitive pleural procedures as compared to repeat thoracentesis for recurrence of MPE resulted in fewer future pleural procedures (0.62 vs. 1.44 procedures per patient respectively, p<0.0001), fewer pneumothoraxes (<0.0037 vs. 0.009 pneumothoraxes per patient, p=0.001), and fewer emergency room procedures (0.02 vs. 0.04 emergency room procedures per patient, p<0.001). However, repeat thoracentesis and IPCs resulted in fewer inpatient days as compared to chest tube or thoracoscopic pleurodesis (0.013 vs. 0.013 vs. 0.085 vs. 0.097 inpatient days per day of life respectively, p<0.001). Factors associated with guidelines consistent care included living in a big metropolitan area, specialists performing the first procedure, having the procedure in the emergency room, younger patient age, and having a diagnosis of lung cancer. CONCLUSIONS: Guideline consistent care using definitive procedures as compared to repeat thoracentesis is associated with fewer future procedures and complications. CLINICAL IMPLICATIONS: Attention to physician training and developing disease management pathways that facilitate prompt follow-up of MPE is needed to address the quality gap observed. DISCLOSURE: The following authors have nothing to disclose: David Ost, Jiangong Niu, Horiana Grosu, Sharon Giordano No Product/Research Disclosure Information

Prognostic factors of mortality and recurrence of malignant pleural effusion in high-risk tumors according to the LENT Score.

e21666 Background: The aim of this study was to identify predictors of overall survival (OS) and recurrence after palliative pleural procedures in patients with malignant pleural effusion (MPE) and high-risk tumors according to the LENT Score. Methods: Data was collected from our database between January 2013 and December 2015 of patients with MPE and high-risk tumors according to the LENT Score. All patients were followed-up for at least 30 days after the pleural procedure. We evaluated radiological aspects, biochemical and hematologic parameters as well as clinical features. For OS analysis, patients were divided into two groups. Group I included OS &lt; 30 days and group II included OS &gt; 30 days. Prognostic factors for pleural recurrence and OS were identified by univariate analysis, using Fisher's exact and Student's t-test. Subsequently, significant variables were entered into a multivariate logistic regression analysis ( p &lt; 0.05). Results: A total of 134 patients were included. Median follow-up time for surviving patients was 56 (range: 2-623) days. High-risk primary tumors included lung (66.4%), gastrointestinal (24.6%) , sarcoma (3.7%), urologic (3.7%) and others (1.5%). Forty-four patients in Group I had OS &lt; 30 days while 22 patients had MPE recurrence. Factors affecting OS in univariate analysis were: type of procedure, ECOG, albumin, leukocytes, neutrophil to lymphocyte ratio( NRL) and hemoglobin. Factors affecting recurrence were: type of procedure, chemotherapy line (CT), albumin and platelets. In multivariate analysis for Group I, type of procedure (therapeutic pleural aspiration – TPA) ( p= 0.011), ECOG 3/4 ( p= 0.004), NLR &gt; 5 ( p= 0.037) and leukocytes &gt; 8000 ( p= 0.042) were identified as independent predictors of OS. In terms of recurrence, only CT beyond first line ( p = 0.042) was identified as an independent prognostic factor. Conclusions: Patients with MPE who underwent TPA, had ECOG 3/4, leukocytes &gt; 8000, and NLR &gt; 5 were significantly associated with shorter OS,. CT beyond first line was associated with recurrence. The identification of these prognostic factors may assist physicians in choosing the optimal palliative technique.

Efficacy and Safety of Povidone-iodine Pleurodesis in Malignant Pleural Effusions.

Introduction:Malignant pleural effusion (MPE) is determined by the detection of malignant cells in pleural fluid or pleural tissue. Neoplasm of lung, breast, ovary and lymphoma are the causes of more than 75% of MPE. Pleurodesis is a usual technique in the management of MPE to achieve a symphysis between two layers of the pleura, and various chemical agents have been used in an attempt to produce pleurodesis. With regard to complications and limitations of these sclerosing agents, efficacy and safety of povidone-iodine have been investigated in this study.Materials and Methods:Between June 2014 and June 2016, 63 consecutive patients were admitted to the Department of Thoracic Surgery because of symptomatic MPE. After insertion of a chest tube, pleurodesis with instillation of povidone-iodine was performed. Thyroid and renal function tests were checked, and success rate as well as recurrence of MPE was monitored in the next follow-up visits.Results:The complete response to this procedure was about 53.57%, and failure of treatment was 10.71% with efficacy of 82.2%. The most common complication was pain during instillation (26.9%). Changes in thyroid and renal function tests were not significant.Conclusion:Povidone-iodine is a safe and effective agent with minor side effects in pleurodesis of patients with MPEs and can be used as an accessible and low-cost alternative than other sclerosing agents.