Pulmonary Self-Study Resources-Bibby, ERS EACTS statemen on magmt of MPE, ERS 2018

Pdf Summary

The ERS/EACTS statement on the management of malignant pleural effusions (MPEs) provides a comprehensive review of existing practices and recent advancements based on high-quality randomized clinical trials. MPEs are prevalent in patients with advanced cancers, often resulting in symptomatic conditions such as breathlessness. The primary focus of treatment remains palliative.<br /><br />Key findings and recommendations from the statement include:<br />1. **Management of Symptomatic MPEs**:<br />   - Talc pleurodesis and indwelling pleural catheters (IPCs) are effective in managing MPE symptoms, with IPCs offering reduced hospitalization time but a potential increase in adverse events.<br />   - Thoracoscopic talc poudrage via VATS (video-assisted thoracoscopic surgery) or medical thoracoscopy may provide better fluid control compared to talc slurry, but more research is needed.<br /><br />2. **Trapped Lung in MPEs**:<br />   - Evidence suggests IPCs are beneficial for patients with trapped lung, improving symptoms. However, further randomized trials are necessary to solidify these findings.<br /><br />3. **Loculated MPEs**:<br />   - Intra-pleural fibrinolytic agents can improve fluid drainage and radiographic appearances in loculated effusions, though their impact on clinical outcomes such as symptom relief remains unclear.<br /><br />4. **Prognostic Factors**:<br />   - Tumor type, stage, performance status, and inflammatory markers are important in predicting patient prognosis. The LENT score is a validated prognostic tool for MPE, and Brims’ decision tree is effective for mesothelioma prognostication.<br /><br />5. **Oncological Therapies Prior to MPE Management**:<br />   - No robust evidence currently exists to suggest oncological therapies should replace traditional MPE drainage methods. Chemotherapy and targeted therapies (e.g., EGFR-TKIs for EGFR-positive NSCLC) show promise but require further research.<br /><br />6. **Histological Diagnosis**:<br />   - While cytology can diagnose some malignancies, pleural biopsy remains the gold standard due to its higher sensitivity and ability to provide comprehensive diagnostic, prognostic, and therapeutic information. Molecular profiling technologies show promise but are still under investigation.<br /><br />The statement concludes that while significant progress has been made in the management of MPEs, further research is required, especially in areas concerning trapped lungs and loculated effusions. The recommendations serve as a basis for treating MPEs but underline the need for continued research and innovation.

Meta Tag

Asset Type PDF

Curriculum Category Pleural Disease

Curriculum Subcategory Diagnostic and therapeutic procedures

Keywords

malignant pleural effusions

MPE management

talc pleurodesis

indwelling pleural catheters

trapped lung

loculated effusions

prognostic factors