Chest
Selected ReportsCatheter-Tract Metastases Associated With Chronic Indwelling Pleural Catheters
Section snippets
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
References (5)
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Chest
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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.