Malignant pleural effusions

Starr AN, Vexler A, Marmor S, Konik D, Ashkenasi-Voghera M, Lev-Ari S, Greif Y, Ben-Yosef R. 2005. Establishment and characterization of a pancreatic carcinoma cell line derived from malignant pleural effusion. Oncology 69 239-245. 

Yano, S., Nokihara, H., Hanibuchi, M., Parajuli, R, Shinohara, T., Kawano, T. and Sone, S. (1997). Model of malignant pleural effusion of human lung adenocarcinoma in SCID mice. Oncol. Res. 9, 573-579. 

Masuno T, Kishimoto S, Ogura T, Honma T, Niitani H, Fukuoka M, Ogawa N. A comparative trial of LC9018 plus doxorubicin and doxorubicin alone for the treatment of malignant pleural effusion secondary to lung cancer. Cancer 1991 68(7) 1495-500. 

Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med 1994 120(l) 56-64. 

When bleomycin is used as a sclerosing agent in adults, a dose of up to 1 mg/kg is generally instilled into the chest through a thoracostomy tube. Bleomycin 60 mg intrapleu-rally caused a fever over 39°C in two of 21 patients with malignant pleural effusions it settled without treatment and was not associated with local discomfort (15). 

Hsu NY, Chen C. Intrapleural bleomycin in the management of malignant pleural effusion. J Surg Assoc ROC... 

Ruckdeschel JC, Moores D, Lee JY, Einhorn LH, Mandelbaum I, Koeller J, Weiss GR, Losada M, Keller JH. Intrapleural therapy for malignant pleural effusions. A randomized comparison of bleomycin and tetracycline. Chest 1991 100(6) 1528-35. 

Inactivated Corynebacterium parvum has been tried as an adjuvant in patients with cancer and in the treatment of malignant pleural effusions. Fever and chiUs were frequent, with sustained fever and chest or abdominal pain in several patients (1,2). 

Forest V. Intrapleural Corynebacterium parvum for recurrent malignant pleural effusions. Respiration 1995 62(l) 21-6. 

Patz EF Jr, McAdams HP, Erasmus JJ, Goodman PC, Culhane DK, Gilkeson RC, Herndon J. Sclerotherapy for malignant pleural effusions a prospective randomized trial of bleomycin vs doxycycline with small-bore catheter drainage. Chest 1998 113(5) 1305-11. 

Of 51 patients with malignant pleural effusions, 14 underwent slurry talc pleurodesis via a chest tube, 14 had talc poudrage during Video-Assisted Thoracoscopic exploration of the pleural cavity for suspected malignant effusion, and 24 underwent chemical pleurodesis with bleomycin via a chest tube (16). The most common adverse effects were chest pain and fever. The duration of adverse effects after talc pleurodesis was longer (2-3 days) than after bleomycin. There was chest pain in 15 of the 28 patients who received talc, with a duration of 18-52 (median 31) hours. There was fever in 22 of those who received talc, with a duration of 5-34 (median 12.5) hours. Complications were more common in those who received talc, such as thoracic empyema n — 1), wound infection n — 2), and respiratory distress n — 5). 

Since the literature on this topic largely comprises case reports and retrospective reviews, it is possible that complications may have been under-reported. In addition, there is marked variability in the reported incidence of respiratory complications from series to series, and there is the additional confounding factor that malignant pleural effusion, a condition with a poor short-term survival and significant associated morbidity, is often the... 

Deslauriers J, Beauchamp J, Desmeules M. Pleural neoplasms and malignant pleural effusion. In Bane AE, Geha AS, Hammond GL, Laks H, Naunheim KS, editors. Glenn s Thoracic and Cardiovascular Surgery. 5th ed. Prentice-Hall International Inc, 1991 l 473-8. 

Sahn SA. Malignant pleural effusions. In Shields TW, LoCicero J, Ponn RB, editors. General Thoracic Surgery. 5th ed. Philadelphia Lippincott Williams and Wilkins, 2000 1 795-803. 

Todd TR, Delarue NC, Uves R, Pearson FG, Cooper JD. Talc poudrage for malignant pleural effusion. Chest 1980 78 542-3. 

Martinez-Moragon E, Aparicio J, Rogado MC, Sanchis J, Sanchis F, Gil-Suay V. Pleurodesis in malignant pleural effusions a randomized study of tetracycline versus bleomycin. Eur Respir J 1997 10(10) 2380-3. 

Bleomycin (Bleo, Blenoxane) -NHL, HD testicular cancer squamous cell cancers of the head and neck, cervix, skin, penis, or vulva malignant pleural effusions KS... 

Bonnefoi H, Smith IE. How should cancer presenting as a malignant pleural effusion be managed Br / Cancer. 1996 74 832-835. 

Thicken DR, Armstrong L, Millar AB. Vascular endothelial growth factor (VEGF) in inflammatory and malignant pleural effusions. Thorax. 1999 54 707-710. 

Metastatic CUP to the lungs with parenchymal metastases or isolated malignant pleural effusion... 

Talc, sterile powder, is an antineoplastic agent, that induces an inflammatory reaction, which promotes adherence of the visceral and parietal pleura, obliterating the pleural space and preventing reaccumulation of pleural fluid. It decreases or prevents recurrence of malignant pleural effusions. 

Bleomycin is highly effective against germ cell tumors of the testis and ovary. In testicular cancer it is curative when used with cisplatin and vinblastine or cisplatin and etoposide. It is used as a component of the standard ABVD regimen for Hodgkin s disease. Bleomycin also is given intrapleurally (60 U)for malignant pleural effusions. 

Care of the patient receiving an antineoplastic drug depends on factors such as the drug or combination of dru given, the dos e of the dru, tlie route of administration, the patient s physical response to tlierapy, the response of the tumor to chemotlierapy, and tlie type and severity of adverse reactions. Some dru may be administered by various rout, depending on tlie cancer being treated. Fbr example tliiotepa may be administered by the intravenous route for breast cancer, intravesical route for superficial bladder cancer, intrapleural route for malignant pleural effusions, and by tlie intraperitoneal route for ovarian cancer. 

ENA-78(CXCL5), another neutrophil chemokine, has been demonstrated to be the predominant chemokine in pleural fluids from patients with uncomplicated parapneumonic effusions. Neutrophil counts correlate with ENA-78 in these patients however, in patients with empyema where the disease has been present for a certain period of time and is associated with bacteria in the pleural space, IL-8 was the predominant chemokine and correlated with the level of neutrophils in empyema fluid (17). In comparison, patients with congestive heart failure have minimal, barely measurable quantities of IL-8 in their pleural fluids (16). Though malignant pleural effusions and those secondary to tuberculosis have mild chemotactic activity for neutrophils present in the pleural fluid, the quantity of IL-8 is significantly lower (0.56 0.5 ng/mL for malignant effusions to 0.28 0 ng/mL in patients with tuberculosis) (16). 

The three-amino acid motif (ELR) is conserved in members of the C-X-C family that activate neutrophils. In contrast, the absence of the ELR motif causes inhibition of angiogenesis in C-X-C chemokines. It is probable that the sanguineous nature of malignant pleural effusions is in part due to the rapid development of fragile, new capillaries caused by the angiogenic chemokines associated with the metastatic deposits. This is validated on thoracoscopy where metastatic deposits of cancer are noted to have a nebula of fine branching blood vessels around its perimeter (44). 

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