Simple intrapleural hyperthermia at thoracoscopic exploration to treat malignant pleural effusion.
BACKGROUND
Malignant pleural effusion (MPE) occurs at a terminal stage of cancer, and related symptoms may considerably reduce a patient's respiratory function and quality of life. We assessed the benefit of simple intrapleural hyperthermia (SIH) during thoracoscopic exploration for MPE.


METHODS
We conducted a retrospective review of 34 patients underwent thoracoscopic exploration and SIH procedures for MPE between April, 2009 and July, 2014 at our institution. One month after removal of the tube, therapeutic efficacy was evaluated, calculating response rates and recurrence rate.


RESULTS
In this cohort (male, 11; female, 23; average age, 54.2 ± 12.7 years), the most frequent primary cancers were breast (n = 11, 32.4 %), lung (n = 10, 29.4 %), and ovarian (n = 6, 17.6 %). Therapeutic response (ie, presence of pleural effusion) was assessed 1 month after chest tube removal, with 19 (55.9 %) showing complete response (CR), 9 (26.5 %) showing partial response (PR), and non-response (NR) seen in 6 (17.6 %). The combined (CR + PR) response rate was 82.4 %. During follow-up, there were seven instances of recurrence, requiring repeat drainage. Three- and 7-month recurrence-free rates were 86.9 and 73.9 %, respectively. No postoperative respiratory complications or fever developed. Early death within 3 months from progression of primary cancer was identified as a risk factor in patients of NR status (HR = 18.36, p = 0.043).


CONCLUSIONS
If thoracoscopic exploration is indicated for MPE, SIH is a safe and effective management alternative in patients whose primary malignancy is not rapidly progressing.
Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic Medical Center School of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Seocho-gu, 06591, Republic of Korea. mh-myk@hanmail.net.
Youngkyu
Y
Moon
Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic Medical Center School of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Seocho-gu, 06591, Republic of Korea. cskks@catholic.ac.kr.
Kyung Soo
KS
Kim
Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic Medical Center School of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Seocho-gu, 06591, Republic of Korea. jaekpark@catholic.ac.kr.
Jae Kil
JK
Park
D000328:Adult; D000368:Aged; D015505:Chest Tubes; D004322:Drainage; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D018700:Pleurodesis / Q000009:adverse effects / Q000379:methods*; D011788:Quality of Life; D012074:Remission Induction; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods; D016896:Treatment Outcome