title: Catheter tract metastasis associated with indwelling pleural catheters.
abstract: BACKGROUND
  Indwelling pleural catheters (IPCs) are commonly used to manage malignant effusions. Tumor spread along the catheter tract remains a clinical concern for which limited data exist. We report the largest series of IPC-related catheter tract metastases (CTMs) to date, to our knowledge.
  
  
  METHODS
  This is a single-center, retrospective review of IPCs inserted over a 44-month period. CTM was defined as a new, solid chest wall lesion over the IPC insertion site and/or the tunneled subcutaneous tract that was clinically compatible with a malignant tract metastasis.
  
  
  RESULTS
  One hundred ten IPCs were placed in 107 patients (76.6% men; 60% with mesothelioma). CTM developed in 11 cases (10%): nine with malignant pleural mesothelioma and two with metastatic adenocarcinoma. CTM often developed late (median, 280 days; range, 56-693) post-IPC insertion. Seven cases had chest wall pain, and six received palliative radiotherapy to the CTM. Radiotherapy was well tolerated, with no major complications and causing no damage to the catheters. Longer interval after IPC insertion was the sole significant risk factor for development of CTM (OR, 2.495; 95% CI, 1.247-4.993; P = .0098) in the multivariate analyses.
  
  
  CONCLUSIONS
  IPC-related CTM is uncommon but can complicate both mesothelioma and metastatic carcinomas. The duration of interval after IPC insertion is the key risk factor identified for development of CTM. Symptoms are generally mild and respond well to radiotherapy, which can be administered safely without removal of the catheter.
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital; School of Medicine and Pharmacology, University of Western Australia; Lung Institute of Western Australia, Perth, WA, Australia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Thomas
authors.affiliation: Department of Research, Sir Charles Gairdner Hospital.
authors.forename: Charley A
authors.initials: CA
authors.lastname: Budgeon
authors.affiliation: Department of Radiology, Sir Charles Gairdner Hospital.
authors.forename: Yi Jin
authors.initials: YJ
authors.lastname: Kuok
authors.affiliation: Lung Institute of Western Australia, Perth, WA, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Read
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia; Centre for Applied Statistics, University of Western Australia; Lung Institute of Western Australia, Perth, WA, Australia.
authors.forename: Edward T H
authors.initials: ETH
authors.lastname: Fysh
authors.affiliation: Department of Radiation Oncology, Sir Charles Gairdner Hospital.
authors.forename: Sean
authors.initials: S
authors.lastname: Bydder
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital; School of Medicine and Pharmacology, University of Western Australia; Centre for Applied Statistics, University of Western Australia; Lung Institute of Western Australia, Perth, WA, Australia. Electronic address: gary.lee@uwa.edu.au.
authors.forename: Y C Gary
authors.initials: YCG
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000532:radiotherapy / Q000556:secondary*; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology / Q000532:radiotherapy / Q000556:secondary*; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology / Q000532:radiotherapy / Q000556:secondary*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D015999:Multivariate Analysis; D016066:Pleural Effusion, Malignant / Q000209:etiology* / Q000628:therapy*; D010997:Pleural Neoplasms / Q000150:complications* / Q000473:pathology; D011878:Radiotherapy; D012189:Retrospective Studies; D012307:Risk Factors; D013899:Thoracic Neoplasms / Q000453:epidemiology / Q000532:radiotherapy / Q000556:secondary*; D013997:Time Factors; D016896:Treatment Outcome