Chest
Volume 131, Issue 4, April 2007, Pages 1232-1234
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Selected Reports
Catheter-Tract Metastases Associated With Chronic Indwelling Pleural Catheters

https://doi.org/10.1378/chest.06-2353Get rights and content

Indwelling pleural catheters are increasingly being used for ambulatory treatment of malignant pleural effusion, particularly for patients unsuitable for pleurodesis. These catheters are often left in situ for the rest of the patient's life. Tumor metastasis along the tract between pleura and skin surface is a potential complication in patients with chronic indwelling pleural catheters that has seldom been reported. We describe four cases of catheter-tract metastasis that developed between 3 weeks and 9 months after catheter insertion. Catheter-tract metastasis occurred in two patients with mesothelioma despite prophylactic irradiation at time of insertion, and in two patients with metastatic adenocarcinoma. All cases were successfully treated using external-beam radiotherapy without necessitating catheter removal. A retrospective audit in our center showed that catheter-tract metastasis occurred in 6.7% of 45 patients treated with indwelling pleural catheters for malignant pleural effusions. Both clinicians and patients should be aware of this potential complication.

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Case Report

A large left pleural effusion developed in a 61-year-old woman (Fig 1, 2) 4 months after a left pneumonectomy and chest wall resection for lung adenocarcinoma and preoperative chemotherapy. She had significant symptomatic relief after drainage of pleural fluid, which tested positive for malignant cells. Despite second-line chemotherapy with docetaxel, the effusion reaccumulated rapidly and required frequent drainage. Given the prior pneumonectomy, pleurodesis was regarded as inappropriate.

Retrospective Audit

The above case prompted a retrospective audit of the incidence of catheter-tract metastases from indwelling PleurX catheters in the Oxford Pleural Unit. Between June 2002 and February 2006, 45 PleurX catheters were inserted for drainage of malignant pleural effusions. All patients were followed up by the unit, and any catheter-tract metastases were recorded.

Catheter-tract metastasis developed in 3 of 45 patients (6.7%) [Table 1]. The incidence appeared higher in mesothelioma patients (2 of 15

Discussion

We report four cases of catheter-tract metastasis in patients with pleural malignancies managed with indwelling pleural catheters. Our series include two cases of tract metastasis from adenocarcinomas: a complication seldom reported with cancers other than mesothelioma. In addition, we have shown that catheter-tract metastasis can be treated with external-beam irradiation with the catheter in situ. Prophylactic radiotherapy to the insertion site did not prevent metastasis from indwelling

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Dr. Janes is supported by a Medical Research Council Clinician Scientist Fellowship, Dr. Lee is supported by a Wellcome Advanced Fellowship, and Dr. Rahman is supported by a Medical Research Council Training Fellowship.

Drs. Janes and Rahman do not have any conflict of interests or involvement with organizations with financial interests in the subject matter. Drs. Davies and Lee have been awarded a project grant from the British Lung Foundation to compare conventional pleurodesis with chronic indwelling pleural catheters in patients with malignant pleural effusions. The investigators of the trial have accepted an arrangement to use pleural catheters provided for free by Rocket Med plc (UK), since the acceptance of this manuscript for publication. None of the investigators received any funding from the company.

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