How often is a single therapeutic aspiration sufficient to manage a malignant pleural effusion and does oncological treatment have an impact on this?

Abstract

Introduction: Patients with a malignant pleural effusion (MPE) usually require a definitive intervention to prevent fluid reaccumulation after an initial therapeutic aspiration, often in the form of chest drain and pleurodesis or indwelling pleural catheter insertion. Autopleurodesis can occur in patients who have a chest drain inserted or thoracoscopy without poudrage. At times, oncological treatments may prevent further fluid build-up, but it is unclear what proportion of patients this applies to. Methods: All patients with a new diagnosis of MPE, in our hospital, between 2015-2017 were included. They were catagorised into having one aspiration only, compared to multiple or definitive procedures. Cancer type and treatment information was collected. Results: 309 patients had a newly diagnosed MPE, 6 of whom did not have follow up data. 63 patients did not survive longer than 30 days after the aspiration and 9 patients had a small effusion for a diagnostic aspiration only. 24/232 (10.3%) of patients required only one therapeutic aspiration for management of their MPE. Of these patients 13 had initiation or change of their oncological treatment, the majority were breast or lung cancer. The remaining 11 patients did not have any new treatments but only 4 survived longer than 3 months. A further 86 patients had a change in treatment but required further interventions. Conclusion: Oncological treatment may have prevented the need for further pleural interventions in around 15% of patients. A single aspiration was only sufficient 3.6% of patients who did not have a change in oncological treatment who survived for more than 3 months. Oncological treatment only prevents the need for further interventions in a minority of patients.