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Preventing, Diagnosing and Treating Pleural Infection and Malignant Pleural Effusion
pleurodesis occurred in 70% of patients with good performance status Summary and Conclusions
and a good degree of lung re-expansion who were treated early with Pleural disease secondary to infection and malignancy is a common
an indwelling pleural catheter.
43
problem encountered by many physicians, including family
practitioners, general physicians, surgeons and respiratory specialists.
Recurrent effusions after a failed pleurodesis pose considerable Optimal therapeutic options are still debated and are the subject of
management dilemmas. One option is to attempt repeat pleurodesis, ongoing randomised controlled trials; treatment should certainly be
although the success rate is probably lower than that of the first timely, multidisciplinary and, where possible, evidence-based. ■
pleurodesis. Other options include repeated thoracenteses, indwelling
pleural catheter, surgical pleuroperitoneal shunt or parietal
John M Wrightson is an Academic Clinical Fellow and
pleurectomy. If none of these options is felt to be appropriate,
Respiratory Specialist Registrar in Oxford Centre for
management should be based around domiciliary oxygen and/or
Respiratory Medicine, NIHR Oxford Biomedical Research
opiates for dyspnoea.
Centre, University of Oxford, with research interests
including novel diagnostic strategies in pleural and
pulmonary infections.
The role of prophylactic radiotherapy for patients with mesothelioma
post-pleural procedure remains controversial. Between 10 and 40% of
patients with mesothelioma develop needle tract metastases
Robert JO Davies is a Professor of Respiratory Medicine
secondary to pleural interventions; it is unclear whether this
at NIHR Oxford Biomedical Research Centre, the
represents spread of mesothelioma in a ‘sheet-like’ fashion across the
University of Oxford and Churchill Hospital. His clinical
serosal surfaces or rather implantation of free-floating tumour cells.
and research interests are in all forms of pleural
disease, in particular malignant effusions and pleural
Randomised controlled trials have yielded conflicting data regarding
infection. He is the lead investigator for the MIST and
use of prophylactic radiotherapy post-pleural procedure; its use is
TIME trials – large multicentre treatment trials in pleural
routine in some centres. Close vigilance for metastases is required
infection and malignancy.
regardless of the strategy chosen.
44
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