Author of

• 10883

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  P1.14 - Poster Session 1 - Mesothelioma (ID 194)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Mesothelioma
  • Presentations: 2
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10889

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    P1.14-006 - Catheter Tract Metastases Associated With Indwelling Pleural Catheters For Malignant Effusions (ID 2342)

    09:30 - 09:30  |  Author(s): R. Thomas
    • Abstract

    Background
    Indwelling pleural catheter (IPC) is commonly used in managing malignant pleural effusion (MPE). Tumor spread along the catheter tract remains a clinical concern for which limited data exist. We report the largest series of catheter tract metastases (CTM).

    Methods
    All patients who had IPC inserted for MPE in our Pleural Service were entered prospectively into a database. A retrospective review of the cases for CTM over a 50-month period from Jan 2009 was conducted. CTM was defined as a new chest wall swelling over the IPC insertion site or the tunneled subcutaneous tract. Patient demographics and risk factors were recorded. Multivariate regression analysis was performed.

    Results
    108 patients (77% male; 60% had mesothelioma) underwent a total of 111 IPC insertions. CTM occurred in 11 (10.2%) patients; 7 were males and 9 had mesothelioma. CTM developed after a median of 280 days (range 56-692 days) post-IPC insertion. 7 patients were symptomatic with chest wall pain and 6 received palliative radiotherapy for CTM. Radiotherapy was tolerated well with no major complications. CTM occurred more commonly, OR 3.30 (0.68-16.06), in mesothelioma patients than those with metastatic pleural cancers. Patients who had CTM had a significantly longer survival (median 369 days) than those who did not, HR 0.24 (CI 0.08-0.68).

    Conclusion
    Clinicians and patients should be aware that CTM could complicate IPC, especially in mesothelioma patients. The longer the patient survived after IPC placement, the higher risk of developing CTM. Symptoms associated with CTM were generally mild and responded well to palliative radiotherapy.

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    P1.14-007 - Intrapleural Fibrinolysis Is Effective In Treating Symptomatic Loculation Complicating Indwelling Pleural Catheter Drainage (ID 3017)

    09:30 - 09:30  |  Author(s): R. Thomas
    • Abstract

    Background
    Indwelling pleural catheters (IPC) are commonly used in managing malignant pleural effusions (MPE). Development of loculations within the effusion can prohibit effective fluid drainage. Intrapleural instillation of fibrinolytics has been used though little data exist on this practice. Aim: To describe a single centre experience in the use of fibrinolytic therapy for symptomatic loculation in IPC patients.

    Methods
    We defined Symptomatic Loculation (SL) as presence of (a) residual pleural effusion that failed to be evacuated via a patent IPC, b) breathlessness clinically judged to be related to the residual effusion, and c) in the absence of pleural infection. All patients (n=108; 77% male) who had IPC (n=111) inserted for MPE (60% mesothelioma) were entered prospectively into a database over a 50month period. The incidence of SL and the effectiveness and safety of fibrinolytic therapy were analyzed.

    Results
    The incidence of SL was 1 case per 74.2 IPC person-months, affecting 9% (10/111) of the patients. Most affected were males (9/10) with a mean age of 74.2yrs and 7/10 had mesothelioma. Various fibrinolytics had been used: tPA 10mg (n=6), streptokinase 250000U (n=1), urokinase 100000U (n=2) and 1 patient received a combination of streptokinase followed by tPA. Outcomes: The majority (89%) of patients reported subjective symptomatic improvement in breathlessness. Fibrinolysis induced a significant increase in fluid output: 1459ml (mean after 24hrs) and 2136ml (72 hours after instillation). The mean hospital stay was 4.5 days from first treatment dose. Treatment was well tolerated. The most common symptom was pain on pleural drainage (8 patients) that resolved with cessation of drainage. There were no severe adverse events, such as pleural bleeding. However, SL recurred after fibrinolytic therapy in 5 (56%) patients after a mean period of 9.6 days with two needing further pleural interventions.

    Conclusion
    Intra-pleural fibrinolytic therapy is an effective and safe option for management of SL following IPC insertion for MPE. Support: Cancer Council WA; NHMRC Fellowship (YCGL) Conflict of interest: Nil.