Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review.
BACKGROUND
Malignant pleural effusions (MPE) are a frequent cause of dyspnea and discomfort at the end of cancer patients' lives. The tunneled indwelling pleural catheter (TIPC) was approved by the FDA in 1997 and has been investigated as a treatment for MPE.


OBJECTIVE
To systematically review published data on the efficacy and safety of the TIPC for treatment of MPE.


METHODS
We searched the MEDLINE, EMBASE, and ISI Web of Science databases to identify studies published through October 2009 that reported outcomes in adult patients with MPE treated with a TIPC. Data were aggregated using summary statistics when outcomes were described in the same way among multiple primary studies.


METHODS
Symptomatic improvement and complications associated with use of the TIPC.


RESULTS
Nineteen studies with a total of 1,370 patients met criteria for inclusion in the review. Only one randomized study directly compared the TIPC with the current gold standard treatment, pleurodesis. All other studies were case series. Symptomatic improvement was reported in 628/657 patients (95.6%). Quality of life measurements were infrequently reported. Spontaneous pleurodesis occurred in 430/943 patients (45.6%). Serious complications were rare and included empyema in 33/1168 patients (2.8%), pneumothorax requiring a chest tube in 3/51 (5.9%), and unspecified pneumothorax in 17/439 (3.9%). Minor complications included cellulitis in 32/935 (3.4%), obstruction/clogging in 33/895 (3.7%) and unspecified malfunction of the catheter in 11/121 (9.1%). The use of the TIPC was without complication in 517/591 patients (87.5%).


CONCLUSIONS
Based on low-quality evidence in the form of case series, the TIPC may improve symptoms for patients with MPE and does not appear to be associated with major complications. Prospective randomized studies comparing the TIPC to pleurodesis are needed before the TIPC can be definitively recommended as a first-line treatment of MPE.
Van Meter
Margaret E M
ME
Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 10, Houston, TX 77030-4009, USA. mevanmeter@mdanderson.org
McKee
Kanako Y
KY
Kohlwes
R Jeffrey
RJ
D000328:Adult; D000367:Age Factors; D002408:Catheters, Indwelling / Q000009:adverse effects; D006801:Humans; D010166:Palliative Care / Q000379:methods; D035422:Pleural Cavity / Q000503:physiopathology; D016066:Pleural Effusion, Malignant / Q000503:physiopathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome