Interventional therapies for malignant pleural effusions: the present and the future

Area of Science:

• Pulmonology
• Oncology
• Interventional Procedures

Background:

• Malignant pleural effusions (MPE) management has evolved, shifting focus from aggressive surgery to minimally invasive techniques.
• Patient-reported outcomes are now the primary goal, guiding clinical trials and treatment strategies for MPE.

Purpose of the Study:

• To review current interventional procedures for malignant pleural effusion (MPE) management.
• To discuss controversies, limitations, and future research needs in MPE care.

Main Methods:

• Overview of therapeutic thoracentesis, pleurodesis (including talc), and indwelling pleural catheter (IPC) drainage.
• Discussion of recent studies on IPC effectiveness and safety.
• Identification of challenges in MPE management, such as predicting outcomes.

Main Results:

• Therapeutic thoracentesis offers temporary relief; pleurodesis is definitive but faces efficacy/safety challenges.
• Indwelling pleural catheters (IPCs) are increasingly accepted for symptom improvement without guaranteed pleural symphysis.
• Recent data support IPC effectiveness and safety in MPE management.

Conclusions:

• Choosing optimal MPE intervention remains challenging due to limited understanding of breathlessness and lack of outcome predictors.
• Further research is needed to improve MPE management, focusing on patient outcomes and personalized treatment selection.
• Less invasive methods are replacing older surgical approaches for MPE.