title: Treatment of malignant ascites.
abstract: The management of malignant ascites is a significant challenge in gastrointestinal medical oncology. Current treatment strategies include diuretic therapy, paracentesis, peritoneal drains, and venous shunts. However, there are no established evidence-based guidelines, and there is a lack of randomized controlled trials identifying optimal therapy. Newer therapies are emerging and will need further study. By summarizing published studies, this review is intended to add some clarity to currently available strategies for the management of malignant ascites associated with hepatobiliary cancers. Notably, however, much of the available data for the management of malignant ascites comes from the gynecologic oncology experience, specifically from studies in ovarian cancer. Therefore, successful approaches used in this malignancy may be lead candidates for development in hepatobiliary cancer-associated ascites and are reviewed in this paper.
authors.affiliation: Beth Israel Medical Center, New York, NY 10003, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Chung
authors.forename: Peter
authors.initials: P
authors.lastname: Kozuch
mesh_terms: D000911:Antibodies, Monoclonal; D001201:Ascites / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D002986:Clinical Trials as Topic; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008297:Male; D020782:Matrix Metalloproteinases / Q000378:metabolism; D008495:Medical Oncology / Q000379:methods; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012107:Research Design; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D020782:Matrix Metalloproteinases
references.citation: Arch Intern Med. 1979 Feb;139(2):235
references.pmid: 434979
references.citation: Am J Hosp Palliat Care. 2002 Jan-Feb;19(1):7-8
references.pmid: 12171427
references.citation: Cancer Res. 1992 Mar 1;52(5):1252-8
references.pmid: 1737387
references.citation: Acta Pathol Microbiol Scand. 1953;33(1):10-21
references.pmid: 13113944
references.citation: N Engl J Med. 1994 Feb 3;330(5):337-42
references.pmid: 8277955
references.citation: J Nucl Med. 1975 Apr;16(4):318-9
references.pmid: 1113189
references.citation: Cancer. 1993 Mar 15;71(6):2027-30
references.pmid: 7680276
references.citation: Med Oncol Tumor Pharmacother. 1992;9(4):177-81
references.pmid: 1342062
references.citation: Gynecol Oncol. 1983 Aug;16(1):6-14
references.pmid: 6884832
references.citation: Surgery. 1983 Mar;93(3):365-73
references.pmid: 6600854
references.citation: Anticancer Res. 1998 Sep-Oct;18(5D):3917-25
references.pmid: 9854504
references.citation: Am J Clin Oncol. 1982 Apr;5(2):167-72
references.pmid: 6178284
references.citation: Am Surg. 2000 Jun;66(6):561-8
references.pmid: 10888132
references.citation: J Pain Symptom Manage. 1998 Aug;16(2):96-101
references.pmid: 9737100
references.citation: J Pain Symptom Manage. 1995 Apr;10(3):237-42
references.pmid: 7629417
references.citation: Cancer. 1984 Nov 15;54(10):2226-30
references.pmid: 6207907
references.citation: J Gastroenterol Hepatol. 2007 Dec;22(12):2161-6
references.pmid: 18031375
references.citation: J Vasc Interv Radiol. 2001 Mar;12(3):373-5
references.pmid: 11287517
references.citation: Ann Oncol. 2007 May;18(5):945-9
references.pmid: 17298959
references.citation: Eur J Surg Oncol. 2006 Aug;32(6):682-5
references.pmid: 16631341
references.citation: Cancer. 1986 Feb 15;57(4):721-7
references.pmid: 2417681
references.citation: Cancer. 1966 Aug;19(8):1096-102
references.pmid: 5912325
references.citation: Clin Oncol (R Coll Radiol). 2003 Apr;15(2):59-72
references.pmid: 12708713
references.citation: Can J Oncol. 1996 Nov;6(2):474-80
references.pmid: 12056099
references.citation: Palliat Med. 1999 Sep;13(5):429-30
references.pmid: 10659116
references.citation: J Clin Oncol. 2003 Oct 15;21(20):3737-43
references.pmid: 14551293
references.citation: Br J Cancer. 2003 Nov 17;89(10):1876-84
references.pmid: 14612896
references.citation: Eur J Surg Oncol. 1990 Feb;16(1):47-53
references.pmid: 1689678
references.citation: Gynecol Oncol. 1978 Feb;6(1):106-10
references.pmid: 413767
references.citation: Eur J Cancer. 2006 Mar;42(5):589-97
references.pmid: 16434188
references.citation: J Nucl Med. 1960 Jul;1:195-8
references.pmid: 13876489
references.citation: Gynecol Oncol. 1997 Jan;64(1):80-7
references.pmid: 8995552
references.citation: Clin Cancer Res. 2007 Jul 1;13(13):3899-905
references.pmid: 17606723
references.citation: Gastroenterology. 1992 Oct;103(4):1302-6
references.pmid: 1397889
references.citation: Anticancer Res. 2000 Jan-Feb;20(1A):155-60
references.pmid: 10769648
references.citation: Anticancer Drugs. 1994 Jun;5(3):305-8
references.pmid: 7522646
references.citation: Am Surg. 2001 Oct;67(10):999-1003
references.pmid: 11603562
references.citation: Eur J Cancer. 1991;27(2):121-5
references.pmid: 1827272
references.citation: Ann Intern Med. 1992 Aug 1;117(3):215-20
references.pmid: 1616215
references.citation: Hepatology. 1988 Sep-Oct;8(5):1104-9
references.pmid: 3417231
references.citation: J Am Med Assoc. 1955 Dec 31;159(18):1704-7
references.pmid: 13271133
references.citation: J Am Coll Surg. 2004 Jun;198(6):999-1011
references.pmid: 15194082
references.citation: Clin Cancer Res. 1996 Jul;2(7):1207-14
references.pmid: 9816289
references.citation: J Surg Oncol. 1982 Aug;20(4):238-42
references.pmid: 6180252
references.citation: Anticancer Res. 1994 Mar-Apr;14(2B):739-45
references.pmid: 7516642
references.citation: Gynecol Oncol. 1992 Oct;47(1):102-9
references.pmid: 1427388
references.citation: Gan To Kagaku Ryoho. 1993 Aug;20(11):1622-5
references.pmid: 8373233
references.citation: Jpn J Clin Oncol. 2007 Dec;37(12):930-5
references.pmid: 18211984
references.citation: Am Surg. 1997 Feb;63(2):137-43
references.pmid: 9012427
references.citation: Cancer. 1989 Sep 1;64(5):1029-33
references.pmid: 2758381
references.citation: Surg Oncol Clin N Am. 2003 Jul;12(3):865-72, xvi-xvii
references.pmid: 14567037
references.citation: N Engl J Med. 2004 Apr 15;350(16):1646-54
references.pmid: 15084697
references.citation: In Vivo. 1991 Nov-Dec;5(6):579-81
references.pmid: 1810442
references.citation: J Cancer Res Clin Oncol. 1992;118(7):547-50
references.pmid: 1624547
references.citation: Cancer. 1982 Sep 15;50(6):1204-9
references.pmid: 7104966
references.citation: Surgery. 1983 Mar;93(3):357-64
references.pmid: 6187080
references.citation: Eur J Surg Oncol. 1996 Jun;22(3):237-9
references.pmid: 8654603
references.citation: Clin Cancer Res. 1998 Aug;4(8):1899-902
references.pmid: 9717817
references.citation: Cancer. 1986 Feb 1;57(3):461-4
references.pmid: 2417677
references.citation: Invest New Drugs. 1999;17(4):387-99
references.pmid: 10759405
references.citation: Oncology. 2001;61(3):192-6
references.pmid: 11574774
references.citation: J Clin Oncol. 1990 Dec;8(12):2054-61
references.pmid: 2230897
references.citation: Support Care Cancer. 2000 Nov;8(6):493-9
references.pmid: 11094995
references.citation: Cancer Res. 1998 Jun 15;58(12):2594-600
references.pmid: 9635584
references.citation: Acta Cytol. 1993 Jul-Aug;37(4):483-8
references.pmid: 8328242
references.citation: J Pain Symptom Manage. 2000 Mar;19(3):193-9
references.pmid: 10760624
references.citation: J Vasc Interv Radiol. 2004 Oct;15(10):1129-31
references.pmid: 15466800
references.citation: J Am Med Assoc. 1958 Feb 8;166(6):597-9
references.pmid: 13502033
references.citation: Clin Oncol (R Coll Radiol). 2005 Apr;17(2):118-21
references.pmid: 15830574
references.citation: Eur J Surg Oncol. 1997 Dec;23(6):526-31
references.pmid: 9484924
references.citation: Ann Surg Oncol. 1994 Sep;1(5):378-81
references.pmid: 7531600
references.citation: Oncologist. 2000;5 Suppl 1:45-50
references.pmid: 10804091
references.citation: J Chir (Paris). 1997 Nov;134(5-6):237-42
references.pmid: 9772980
references.citation: Arch Intern Med. 1959 Nov;104:802-15
references.pmid: 13818972