Management of Malignant Pleural Effusion
Summary
Malignant pleural effusion (MPE) arises when malignant cells invade the pleural space, leading to fluid accumulation that impairs respiratory mechanics and quality of life. Initial evaluation centres on imaging (chest radiography, ultrasound, CT) and diagnostic thoracentesis to confirm exudative, malignant fluid by cytology and biochemical analysis. Management objectives include symptomatic relief, restoration of lung function and prevention of recurrence. Simple evacuation via therapeutic thoracentesis provides rapid relief but often requires repetition. Chemical pleurodesis, most commonly with talc or doxycycline, promotes pleural symphysis to avert fluid re-accumulation, whereas indwelling pleural catheters (IPCs) offer a domiciliary drainage option for patients unsuitable for pleurodesis. Surgical interventions such as video-assisted thoracoscopic surgery (VATS) with pleurodesis or pleurectomy are reserved for selected patients with adequate performance status. In parallel, systemic anti-cancer treatments—including targeted therapies and immunotherapies—can reduce effusion by controlling tumour burden. Prognostic scoring systems incorporating performance status, tumour type and biochemical markers guide personalised care. Recent advances in biomarker discovery and molecular profiling are refining prediction of recurrence risk and informing novel therapeutic strategies. Overall, an integrated, multidisciplinary approach that balances efficacy, patient preference and resource considerations underpins contemporary MPE management globally.
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Management of Malignant Pleural Effusion publication trend
The graph below shows the total number of articles in management of malignant pleural effusion across all publications each year (not limited to Nature Index journals).
Technical terms
Therapeutic thoracentesis: Removal of pleural fluid via needle or catheter to relieve dyspnoea.
Pleurodesis: Induction of pleural adhesion using sclerosing agents to prevent fluid re-accumulation.
Indwelling pleural catheter (IPC): A tunneled catheter enabling regular outpatient drainage of pleural fluid.
Mesothelial-mesenchymal transition (MesoMT): Phenotypic shift of mesothelial cells towards a mesenchymal, pro-fibrotic state.
Ferroptosis: Iron-dependent regulated cell death characterised by lipid peroxidation, implicated in cancer cell survival.
References
- Characterization of the pleural microenvironment niche and cancer transition using single-cell RNA sequencing in EGFR-mutated lung cancer. Theranostics (2023).
- Single‐cell transcriptomics reveal metastatic CLDN4+ cancer cells underlying the recurrence of malignant pleural effusion in patients with advanced non‐small‐cell lung cancer. Clinical and Translational Medicine (2024).
- Important prognostic factors for survival in patients with malignant pleural effusion. BMC Pulmonary Medicine (2015).
- Malignant Pleural Effusion and Its Current Management: A Review. Medicina (2019).
About these summaries
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