Efficacy and safety of pleurodesis for lung cancer patients with interstitial lung disease.

IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM
Journal of thoracic disease Pub Date : 2025-02-28 Epub Date: 2025-02-27 DOI:10.21037/jtd-24-1541
Hirokazu Iso, Akihiko Miyanaga, Yozo Sato, Yukari Shirakura, Kaoruko Shinbu, Tomoyasu Inoue, Atsuhiro Nagano, Kazuhito Misawa, Takehiro Tozuka, Akari Murata, Katsuyuki Higa, Susumu Takeuchi, Masaru Matsumoto, Koichiro Kamio, Kazuo Kasahara, Masahiro Seike
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引用次数: 0

Abstract

Background: Managing malignant pleural effusion (MPE) with pleurodesis is essential for symptom relief and minimizing the need for repeated thoracentesis. Interstitial lung disease (ILD) is one of the most common complications associated with advanced lung cancer. However, the efficacy and safety of pleurodesis for MPE secondary to lung cancer with ILD remains unclear. This study aimed to evaluate the efficacy and safety of pleurodesis in this population.

Methods: This study was a single-center retrospective analysis. The cases of pleurodesis in patients with MPE secondary to lung cancer complicated with ILD at Nippon Medical School Hospital (Tokyo, Japan) between January 2010 and December 2022 were included.

Results: Of the 26 lung cancer patients with ILD who underwent pleurodesis were analyzed. Fourteen patients received talc and 12 patients received minocycline, respectively. Talc was used in 10 out of 14 patients with drug-induced ILD and radiation-induced lung injury (RILI). In contrast, minocycline was used in 10 out of 12 patients with idiopathic interstitial pneumonias (IIPs). One month after pleurodesis, the efficacy for pleural adhesions was 64.3% and 50.0% in the talc and minocycline groups. The presence of a partially expanded lung before pleurodesis was a predictive factor for failure [odds ratio: 7.00, 95% confidence interval (CI): 1.20-40.83, P=0.04]. When excluding the patients presenting partially expanded lung, the efficacy rate was 77.8% and 71.4% in the talc and minocycline groups. One case of grade 5 acute respiratory distress syndrome (ARDS) was observed in each group. All cases developing ARDS had been treated with systemic prednisolone against ILDs presenting ground glass opacity and consolidation within 6 months before pleurodesis.

Conclusions: Pleurodesis is considered to be one of the treatment options against MPE in patients with ILD. However, two cases of ARDS were observed; thus, clinicians should carefully consider the indication of pleurodesis in the patients who had the recent onset of ILD and were treated with systemic prednisolone.

胸膜切除术治疗肺癌合并间质性肺疾病的疗效和安全性。
背景:治疗恶性胸腔积液伴胸膜截留是缓解症状和减少重复胸腔穿刺的必要条件。间质性肺病(ILD)是晚期肺癌最常见的并发症之一。然而,胸膜穿刺术治疗肺癌并发ILD继发MPE的疗效和安全性尚不清楚。本研究旨在评价胸膜穿刺术在这一人群中的疗效和安全性。方法:本研究采用单中心回顾性分析。本研究纳入2010年1月至2022年12月在日本东京医学院医院(Tokyo, Japan)进行的MPE继发于肺癌合并ILD患者的胸膜切除术病例。结果:对26例肺癌合并ILD行胸膜切除术的患者进行分析。14例患者接受滑石粉治疗,12例患者接受米诺环素治疗。14例药物性ILD和辐射性肺损伤(RILI)患者中有10例使用滑石粉。相比之下,12例特发性间质性肺炎(IIPs)患者中有10例使用二甲胺四环素。滑石粉组和米诺环素组胸膜粘连的有效率分别为64.3%和50.0%。胸膜切除术前肺部分扩张是手术失败的预测因素[优势比:7.00,95%可信区间(CI): 1.20-40.83, P=0.04]。在排除部分肺扩张患者后,滑石粉组和米诺环素组的有效率分别为77.8%和71.4%。两组各1例发生5级急性呼吸窘迫综合征(ARDS)。所有发生ARDS的病例均在胸膜切除术前6个月内用强的松龙治疗出现磨玻璃样混浊和实变的ild。结论:胸膜固定术被认为是ILD患者抗MPE的治疗选择之一。2例发生ARDS;因此,临床医生应仔细考虑近期发病的ILD患者和全身性泼尼松龙治疗的胸膜穿刺术的适应症。
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来源期刊
Journal of thoracic disease
Journal of thoracic disease RESPIRATORY SYSTEM-
CiteScore
4.60
自引率
4.00%
发文量
254
期刊介绍: The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.
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