ERS/EACTS statement on the management of malignant pleural effusions

Anna C Bibby, Patrick Dorn, Ioannis Psallidas, Jose M Porcel, Julius Janssen, Marios Froudarakis, Dragan Subotic, Phillippe Astoul, Peter Licht, Ralph Schmid, Arnaud Scherpereel, Najib M Rahman, Nick A Maskell, Giuseppe Cardillo

Research output: Contribution to journalArticle (Academic Journal)

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Abstract

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.

Original languageEnglish
Pages (from-to)116-132
Number of pages17
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume55
Issue number1
Early online date27 Jul 2018
DOIs
Publication statusPublished - Jan 2019

Bibliographical note

The article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and the European Respiratory Journal. All rights reserved in respect of the European Journal of Cardio-Thoracic Surgery, © European Association for Cardio-Thoracic Surgery 2018, and in respect of the European Respiratory Journal, © European Respiratory Society 2018. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Either citation can be used when citing this article.

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    Bibby, A. C., Dorn, P., Psallidas, I., Porcel, J. M., Janssen, J., Froudarakis, M., Subotic, D., Astoul, P., Licht, P., Schmid, R., Scherpereel, A., Rahman, N. M., Maskell, N. A., & Cardillo, G. (2019). ERS/EACTS statement on the management of malignant pleural effusions. European Journal of Cardio-Thoracic Surgery, 55(1), 116-132. https://doi.org/10.1093/ejcts/ezy258