Management of malignant pleural effusion

The first part of this thesis focuses on IPCs (indwelling pleural catheters) in malignant pleural effusion (MPE) management. In an invited review, the (dis)advantages and prejudices of IPCs are described (Chapter1.1). Since costs and reimbursement issues are the main reasons in the Netherlands to withhold patients from IPCs, we performed a retrospective analysis of a prospectively collected database. In this database, we registered patient characteristics (gender, tumor type), survival data and IPC supplies. Material costs of IPC treatment were calculated and are presented in Chapter 1.2. Results of a multicenter randomized controlled trial comparing talc pleurodesis (TP) with IPC as first line treatment in The Netherlands are presented in Chapter 1.3.
In part two of this thesis therapeutic thoracenteses are evaluated. Since lung expansion is one of the most important predictors for lung expansion, we focused on lung expansion. Results of a survey on the interpretation of Chest X-rays (CXRs) are discussed in Chapter 2.1. Chest physicians of The Netherlands and Belgium were asked to review 50 CXRs from consecutive patients previously treated for MPE. For each CXR, they were asked whether they considered the lung to be expanded; whether they would instill talc and to estimate the success rate. In the next chapter (Chapter 2.2), pleural manometry was used for early recognition of lung expansion or trapped lung. In contrast to more frequently used methods, we used software to monitor/record pleural pressure with a high frequency. We observed pleural pressure swings during respiration. In Chapter 2.3 we show patient reported outcomes (PROs) after therapeutic thoracentesis and correlate these scores to reinterventions. Finally, in a letter-to-the-editor we comment on a predictor study for definitive MPE treatment. (Chapter 2.4).