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A.W. Mariani



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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-046 - Quality of Life in Patients With Malignant Pleural Effusion Undergoing Pleurodesi (ID 2807)

      09:30 - 09:30  |  Author(s): A.W. Mariani

      • Abstract

      Background
      Pleurodesis is a palliative procedure which main purpose is to alleviate respiratory symptoms of patients with malignant pleural effusion. Nevertheless, quality-of-life is an outcome rarely explored in literature. The main purpose of this study was to evaluate the quality-of-life before and 30 days after pleurodesis in patients with malignant pleural effusion. The secondary objective was to identify predictors of quality-of-life improvement after pleurodesis.

      Methods
      Retrospective study including all patients with recurrent malignant pleural effusion who underwent pleurodesis at Hospital das Clinicas (University of Sao Paulo) and Hospital Aristides Maltez from 2008 until 2012 and who filled out quality-of-life questionnaires before and 30 days after the procedure. In both institutions the World Health Organization-bref general quality-of-life questionnaire has been regularly applied to all patients undergoing pleurodesis since 2007. Paired T-test was used to compare before and after scores and multivariable regression models were used to identify predictors.

      Results
      During the study period 132 patients were included (26 men, 106 women, mean age 58.1 +- 11.8). The primary tumors were: breast (84), lung (25), ovary (4), lymphoma (11) and other (8). The mean prepleurodesis quality-of-life scores were: physical domain 35.8+-17.7, psychological domain 58.8+-17.7, social domain 52.8+-14.8, and environmental domain 65.4+-18.8. Thirty days after pleurodesis, the physical aspect (8.1 pts, p=0.0001) and the environmental domain (3.6 pts, p=0.008) improved significantly while the other two domains remained unchanged. Predictors of improvement of quality-of-life in this sample were: ovary cancer (p=0.015), pleural fluid glucose (p=0.012), and low physical aspect score before pleurodesis (p=0.001).

      Conclusion
      All aspects of quality-of-life are deeply compromised in patients with recurrent malignant pleural effusion. Pleurodesis improves quality-of-life thirty days after the procedure particularly in patients with ovary cancer and with very low physical status scores.

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    P3.06 - Poster Session 3 - Prognostic and Predictive Biomarkers (ID 178)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P3.06-042 - Pleural fluid ADA is associated with survival of patients with malignant pleural effusion (ID 2797)

      09:30 - 09:30  |  Author(s): A.W. Mariani

      • Abstract

      Background
      Estimating survival is desirable to determine the best palliative approach for patients with malignant pleural effusion (MPE). Previous studies have shown that some pleural fluid biochemical parameters as glucose or pH are predictors of survival in such a population. Inflammatory infiltrate profile was already determined as a relevant predictor in solid tumors. However, inflammatory cells profile and lymphocyte activity was not systematically assessed as a survival predictor in MPE patients. Therefore, our objective was to evaluate whether cytology profile and Adenosine Deaminase (ADA) levels are relevant predictors of overall survival in patients with MPE who undergo pleurodesis.

      Methods
      Retrospective cohort study carried out in a tertiary university-based hospital. We included all patients who underwent pleurodesis for MPE treatment in our institution during the period: Jan/08 to Jun/11. We excluded patients that had no pleural fluid analysis registered in our database. The following data regarding pleural fluid analysis were retrieved from our database: glucose, LDH, total proteins and ADA, total cell count, leukocytes, macrophages, neutrophils, lymphocytes and oncotic cytology. All patients were followed up in our outpatient clinic until death, those who were lost to follow-up were contacted by telephone. Cox regression models were built to identify predictors of overall survival

      Results
      156 patients were included in this study (44 men, 112 women, mean age 58.9+-12 years). Primary neoplasms were: breast (83), lung (39), lymphoma (10), other (24). Median survival was 9 months. The final regression model was built using forward stepwise selection and the overall survival predictors identified that levels of ADA below 15 IU/L (HR:2.3, p=0.0008) or above > 40 IU/L. (HR 2.3, p=0.01) are associated with a shorter survival. An association with shorter survival was also found for patients with primary neoplasms different from breast, lung or lymphoma. (HR: 2,1, p= 0.007). No other predictor analyzed was associated with worse prognosis. Exploratory analysis showed that patients with ADA < 15 IU/L had low pleural fluid lymphocytes count and low protein concentration; paradoxically, those with ADA > 40 IU/L also had low lymphocytes count while other parameters were normal.

      Conclusion
      We concluded that ADA is a relevant predictor of survival in patients with MPE who undergo pleurodesis.

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-040 - Iodopovidone for pleurodesis in patients with malignant pleural effusion: a safe option (ID 2771)

      09:30 - 09:30  |  Author(s): A.W. Mariani

      • Abstract

      Background
      Malignant pleural effusion (MPE) is a disabling condition in patients with metastatic disease. Pleurodesis is a well established treatment for recurrent MPE; however, the best sclerosing agent is still a matter of debate. Iodopovidone is described in the literature as a sclerosing agent easily obtained, easy to use, and inexpensive; nevertheless, its safety has not been systematically evaluated. The objective of this study was to analyze the occurrence of frequent (>5%) adverse events after pleurodesis using two different dosages of Iodopovidone in patients with MPE.

      Methods
      Randomized double blind clinical trial including patients with recurrent MPE eligible for pleurodesis. All patients were randomized into two groups; group 1 received 1% Iodopovidone and group 2 received 2% Iodopovidone. We sought adverse events systematically after pleurodesis through pain analog scale, dyspnea scale, oxygen saturation, heart frequency, arterial blood pressure, body temperature, visual acuity, EKG, chest x-ray and laboratory tests (CRP, hemogram, renal function, liver function and thyroid function). All adverse events were registered and classified according to the CTCAEV v3.0. We considered pleurodesis as failed when the patient underwent new pleural procedures. We compared groups as for adverse events, quality-of-life, and success using, chi-square or t-test, p<0.05 was considered significant.

      Results
      Fifty patients underwent pleurodesis over the study period, 45 females and 5 males with a mean age of 56,7 years. The etiology of MPE was breast cancer in 34 patients (68%), lung cancer in 6 patients (12%), and other neoplasms in 10 patients (20%). We found no difference in patient’s demographical data between groups. The most frequent adverse event was elevation of alkaline phosphatase, which occurred in 21 patients (42%), 6 in group 1 and 15 in group 2 (p = 0.03). Hyponatremia was the second most common adverse event, it occurred in 19 patients (38%), 5 in group 1 and 14 in group 2 (p= 0,02). In no patient did these laboratorial alterations require further care. The most frequent clinical adverse event was severe pain, it was observed in 5 patients (10%), 1 patients from group 1 and in 4 patients from group 2 (p=0.69). Hypotension occurred in one patient from each group (p=1). Two patients had postoperative empyema in group 2, and none in group 1 (p=0,35). Other adverse effects or complications commonly reported in the literature such as fever, renal or visual disorder were not found. Pleurodesis success rate was 92% in the Group 1 and 84% in Group 2 (p = 0.5).

      Conclusion
      Clinically relevant adverse events are not frequent after iodopovidone pleurodesis, being pain the most common. Apparently, the occurrence of laboratorial alterations is dose-dependent