Pleural effusion in breast cancer: influence upon clinical course and survival

The clinical course and outcome of 31 women suffering from breast carcinoma with documented pleural involvement was reviewed retrospectively. These 31 patients represent 14% of all patients with metastatic breast cancer seen in our Institution between 1977 and 1982. Most effusions were unilateral and ipsilateral to the affected breast, and the median interval from diagnosis of breast cancer to detection of pleural effusion was 32 months (range 0 to 84). In 55% of the patients, the effusion represented the first site of failure; in patients with known metastatic disease, the median interval from initial failure to the development of pleural effusion was 12 months. Local recurrence in the affected breast or chest wall very frequently preceded the onset of an ipsilateral effusion. Once pleural fluid developed, spread to other visceral organs was common. Treatment regimens were far from uniform and included systemic chemotherapy, hormone therapy or both, as well as intrapleural treatment; 10 of 22 patients (45%) given any form of therapy other than thoracentesis had a significant decrease in the amount of the effusion, including 3 patients with a complete response. The median survival of all patients from the onset of the effusion was 7 months (1-72); complete responders survived a median of 15 months whereas progressors had a median survival of 5 months only. Prognostic characteristics associated with a prolonged survival were: a unilateral effusion, ipsilateral to the primary tumor; effusion as first site of relapse, and mainly, an objective response to therapy. Although this is a small series, patients given both systemic and intracavitary treatment achieved best results.(ABSTRACT TRUNCATED AT 250 WORDS)