The progression to minimally invasive techniques has been almost a natural evolution of the use of video-assisted thoracic surgery (VATS) from the investigation of pleural diseases, such as pneumothorax, and pleural effusion. Surgical resection is the primary treatment for early-stage non-small cell lung cancer (NSCLC). Minimally invasive thoracic surgery has been extensively used in the field of lung cancer. As the procedure has evolved and been studied, thoracoscopic lobectomy has been demonstrated to be a safe and oncologically effective strategy in the surgical management of patients with early stage NSCLC. VATS is a minimally invasive technique that has many advantages in postoperative pain and recovery time. Most surgeons perform VATS for lung cancer with three or more incisions. As the technique of VATS has evolved, single- or double-port VATS for lung cancer has been recently attempted and its advantages have been reported.
Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms* ; Lung* ; Pain, Postoperative ; Pleural Diseases ; Pleural Effusion ; Pneumothorax ; Thoracic Surgery* ; Thoracic Surgery, Video-Assisted

Humans ; Carcinoma, Non-Small-Cell Lung/genetics* ; Lung Neoplasms/genetics* ; Pleural Effusion, Malignant ; Consensus ; China

BACKGROUND: Maligant pleural effusions are common and significant problems in patient with advanced malignancies. In comparison with traditional sclerosing agent, intrapleural chemotherapy has a potential advantage of treating the underlying malignancy in addition to providing local control of th effusion. This study evaluated efficacy of intrapleural chemotherapy with cisplatin and cytarabine in the management of malignant pleural effusion from lung cancer and others. METHODS: 29 patients with pathology-proven malignant pleural effusion were prospectively analyzed to estimate the effect of intrapleural chemotherapy. A single dose of cisplatin 100mg/m plus cytarabine 1200mg/m in the 250ml normal saline were instilled into the pleural space via a chest tube and drained 4 hours later. Patients were evaluated for toxicity and response at 24hours, 1st, 2nd, 3rd week, and monthly interval. No recurrence of the effusion was considered a complete response(CR). Partial responses (PR) was defined as a 75% or greater decrease in the amount of effusion on serial chest radiographs. RESULTS: The overall response rate(CR plus PR) was 93.1% (27 of 29 patients). The median length of response was 7.5 months. Among 17 patients who were assessable until they died, 14 patients(82%) maintained complete response at the last follow-up. One patient experienced reversible grade 4 myelosuppression, 3 patients had grade 3 nausea & vomiting. 2 patients had empyema, and 2 patients had wound infection. CONCLUSIONS: The outcome of this trial indicated that the intrapleural chemotherapy with cisplatin and cytarabine with little treatment related mortality and morbidity.
Chest Tubes ; Cisplatin* ; Cytarabine* ; Drug Therapy* ; Empyema ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Mortality ; Nausea ; Pleural Effusion ; Pleural Effusion, Malignant* ; Prospective Studies ; Radiography, Thoracic ; Recurrence ; Vomiting ; Wound Infection

OBJECTIVETo study the value of video-assisted thoracoscopic surgery (VATS) and identify its indications in synthetic therapy for malignant pleural effusion secondary to non-small cell lung cancer.

METHODSA prospective randomized single-blinded controlled clinical trial was conducted. Fifty-three patients with moderate or large amount of ipsilateral malignant pleural effusion (MPE) secondary to non-small cell lung cancer (NSCLC) were randomly divided into VATS group and tube drainage group (TD group). All patients received chemotherapy with the regimen of paclitaxel combined with paraplatin, and the response rate of MPE after therapy, difference of Karnofsky performance status (KPS) grades before and after therapy and the survival rate of the patients were compared.

RESULTSThe response rate of MPE after therapy in VATS group and TD group was 92.3% and 59.3%, and the complete remission rate was 88.5% and 44.4% (P<0.05), respectively. The difference of KPS grades before and after therapy in VATS group and TD group were 30 and 20, with a mean of 33.5-/+11.3 and 24.07-/+10.5 (P<0.05), respectively. Till August of 2005 years, all patients were available for followed-up, whose median survival time was 20 months in VATS group and 15 months in TD group. The 1-, 2- and 3-year survival rate were 65.4%, 38.5% and 22.4% in VATS group and 59.3%, 25.9% and 14.8% in TD group (P>0.05), respectively.

CONCLUSIONVideo-assisted thoracoscopic pleurectomy can effectively control MPE and improve the quality of life for NSCLC patients with MPE, but failed to significantly improve the patients' survival rate in comparison with tube drainage. Except for grade IV, grades I, II and III according to CT findings all can be indications of VATS.

Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; complications ; Chest Tubes ; Combined Modality Therapy ; Drainage ; Female ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms ; complications ; Male ; Middle Aged ; Pleural Effusion, Malignant ; etiology ; therapy ; Single-Blind Method ; Thoracic Surgery, Video-Assisted ; Treatment Outcome

OBJECTIVE: To determine which computed tomography (CT) imaging features predict pleural malignancy in patients with advanced epithelial ovarian carcinoma (EOC) using video-assisted thoracic surgery (VATS), pathology, and cytology findings as the reference standard. METHODS: This retrospective study included 44 patients with International Federation of Obstetrics and Gynecology (FIGO) stage III or IV primary or recurrent EOC who had chest CT < or =30 days before VATS. Two radiologists independently reviewed the CT studies and recorded the presence and size of pleural effusions and of ascites; pleural nodules, thickening, enhancement, subdiaphragmatic tumour deposits and supradiaphragmatic, mediastinal, hilar, and retroperitoneal adenopathy; and peritoneal seeding. VATS, pathology, and cytology findings constituted the reference standard. RESULTS: In 26/44 (59%) patients, pleural biopsies were malignant. Only the size of left-sided pleural effusion (reader 1: rho=-0.39, p=0.01; reader 2: rho=-0.37, p=0.01) and presence of ascites (reader 1: rho=-0.33, p=0.03; reader 2: rho=-0.35, p=0.03) were significantly associated with solid pleural metastasis. Pleural fluid cytology was malignant in 26/35 (74%) patients. Only the presence (p=0.03 for both readers) and size (reader 1: rho=0.34, p=0.04; reader 2: rho=0.33, p=0.06) of right-sided pleural effusion were associated with malignant pleural effusion. Interobserver agreement was substantial (kappa=0.78) for effusion size and moderate (kappa=0.46) for presence of solid pleural disease. No other CT features were associated with malignancy at biopsy or cytology. CONCLUSION: In patients with advanced EOC, ascites and left-sided pleural effusion size were associated with solid pleural metastasis, while the presence and size of right-sided effusion were associated with malignant pleural effusion. No other CT features evaluated were associated with pleural malignancy.
Ascites ; Biopsy ; Gynecology ; Humans ; Neoplasm Metastasis ; Obstetrics ; Ovarian Neoplasms ; Pleural Diseases ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleural Neoplasms ; Retrospective Studies ; Seeds ; Thoracic Surgery, Video-Assisted ; Thorax

BACKGROUND: In non-small cell lung cancer (NSCLC), malignant pleural effusion is a frequently observed complication, and is an important negative prognostic factor. Although many studies concerned to diagnosis and treatment of malignant pleural effusion have been performed, prognostic factors of malignant pleural effusion have rarely been investigated. This study was performed to determine the prognostic factors of malignant pleural effusion in non-small cell lung cancer. MATERIAL AND METHOD: We evaluated 33 NSCLC patients with malignant effusion treated between January 2002 and December 2003. We analyzed possible factors: gender, age, TNM Stage, fluid analysis (pH, CEA, LDH, glucose, albumin) and treatment modality. Median survival time of each factor was calculated by Kaplan-Meier method and difference of median survival time between groups of factor compared by log-rank test. The Cox proportional hazards regression model was used to confirm the significance of prognostic factor. RESULTS: Of the 33 patients, 23 (69.7%) patients were adenocarcinoma. The median interval of the diagnosis of lung cancer and malignant effusion was 7.3 months (25th~75th: 3.9~11.8), and the median survival time was 3.6 months (95% Confidence Interval: 1.14~5.99). In the univariate analysis, using the log-rank test, those with an adenocarcinoma showed a relatively longer median survival time than those of a non-adenocarcinoma (4.067 vs. 1.867 months, p=0.067) without statistical significance. In the multivariate analysis, using the Cox regression, those with a non- adenocarcinoma showed a trend of high risk of cancer death than those with an adenocarcinoma without statistical significance (Relative risk; 2.754, 95% CI; 0.988~7.672, p=0.053). CONCLUSION: We could not find an independent prognostic factor of malignant pleural effusion in NSCLC. As there was a trend of high risk of cancer death according to histology, further study will be needed.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung* ; Diagnosis ; Glucose ; Humans ; Lung Neoplasms ; Multivariate Analysis ; Pleural Effusion, Malignant* ; Prognosis

BACKGROUND: Lung cancer is the leading cause of malignant pleural effusions, which is currently most commonly treated using pleurodesis via bedside thoracostomy. Several agents had been used for the treatment of pleural sclerosis, but with differing efficacies and associated side effects. Our purpose with this study was to compare the efficacy, side effects and disease free survival times of patients being treated with OK-432 and doxycycline sclerotherapy in lung cancer induced malignant pleural effusions. PATIENTS AND METHODS: 79 patients who underwent pleurodesis with OK-432 and doxycycline, between Jan. 1994 and Aug. 2001, were retrospectively reviewed. Resopnses 30 days following pleurodesis were determined from chest radiographs, with the disease free survival time being evaluated according to the response. RESULTS: The success rates, 30 day followint pleurodesis, with OK-432 and doxycycline 83 and 87%, respectively (p=0.677). With regard to the side effects, fever was more common when OK-432 was used (59%, p=0.001), and pain was more common with doxycycline use (73%, p=0.008). There was no significant difference in disease free survival times between OK-432 (13.6 Months) and doxycycline (11.6 Months) (p=0.532). CONCLUSION: with the use of OK-432, for pleurodesis, was as effective as doxycycline, can be considered as an alternative treatment for malignant effusion in patients with lung cancer.
Disease-Free Survival ; Doxycycline* ; Fever ; Humans ; Lung Neoplasms* ; Lung* ; Picibanil* ; Pleural Effusion, Malignant* ; Pleurodesis* ; Radiography, Thoracic ; Retrospective Studies ; Sclerosis ; Sclerotherapy ; Thoracostomy

BACKGROUND: Lung cancer is the leading cause of malignant pleural effusions, which is currently most commonly treated using pleurodesis via bedside thoracostomy. Several agents had been used for the treatment of pleural sclerosis, but with differing efficacies and associated side effects. Our purpose with this study was to compare the efficacy, side effects and disease free survival times of patients being treated with OK-432 and doxycycline sclerotherapy in lung cancer induced malignant pleural effusions. PATIENTS AND METHODS: 79 patients who underwent pleurodesis with OK-432 and doxycycline, between Jan. 1994 and Aug. 2001, were retrospectively reviewed. Resopnses 30 days following pleurodesis were determined from chest radiographs, with the disease free survival time being evaluated according to the response. RESULTS: The success rates, 30 day followint pleurodesis, with OK-432 and doxycycline 83 and 87%, respectively (p=0.677). With regard to the side effects, fever was more common when OK-432 was used (59%, p=0.001), and pain was more common with doxycycline use (73%, p=0.008). There was no significant difference in disease free survival times between OK-432 (13.6 Months) and doxycycline (11.6 Months) (p=0.532). CONCLUSION: with the use of OK-432, for pleurodesis, was as effective as doxycycline, can be considered as an alternative treatment for malignant effusion in patients with lung cancer.
Disease-Free Survival ; Doxycycline* ; Fever ; Humans ; Lung Neoplasms* ; Lung* ; Picibanil* ; Pleural Effusion, Malignant* ; Pleurodesis* ; Radiography, Thoracic ; Retrospective Studies ; Sclerosis ; Sclerotherapy ; Thoracostomy

Lung cancer is the most commonly diagnosed cancer worldwide. Malignant pleural effusion (MPE) caused by advanced lung cancer seriously affect the patients' quality of life and prognosis. The management of MPE includes thoracentesis, pleurodesis, indwelling pleural catheters and drug perfusion in pleural cavity. Vascular endothelial growth factor (VEGF) and its receptor are a group of important ligands and receptors that affect angiogenesis. They are the main factors controlling angiogenesis, and they play an important role in the formation of MPE. Bevacizumab is a recombinant humanized VEGF monoclonal antibody, competitively binding to endogenous VEGF receptor. Bevacizumab can inhibit new blood vessel formation, reduce vascular permeability, prevent pleural effusion accumulation and slow the growth of cancers. This review aims to discuss the progress of bevacizumab in the treatment of MPE caused by non-small cell lung cancer (NSCLC), and explore the clinical application, efficacy, safety and future direction of bevacizumab.
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Antineoplastic Agents ; therapeutic use ; Antineoplastic Agents, Immunological ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; complications ; pathology ; Humans ; Pleural Effusion, Malignant ; drug therapy ; Pleural Neoplasms ; drug therapy ; secondary

We present a case of an unusual infectious complication of a ruptured mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which led to malignant pleural effusion in a patient with stage IIIA non-small-cell lung cancer. EBUS-TBNA was performed in a 48-year-old previously healthy male, and a mediastinal abscess developed at 4 days post-procedure. Video-assisted thoracoscopic surgery was performed for debridement and drainage, and the intraoperative findings revealed a large volume pleural effusion that was not detected on the initial radiographic evaluation. Malignant cells were unexpectedly detected in the aspirated pleural fluid, which was possibly due to increased pleural permeability and transport of malignant cells originating in a ruptured subcarinal lymph node from the mediastinum to the pleural space. Hence, the patient was confirmed to have squamous cell lung carcinoma with malignant pleural effusion and his TNM staging was changed from stage IIIA to IV.
Abscess* ; Debridement ; Drainage ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Lung ; Lung Neoplasms ; Lymph Nodes* ; Male ; Mediastinum ; Middle Aged ; Needles* ; Neoplasm Staging ; Permeability ; Pleural Effusion ; Pleural Effusion, Malignant* ; Thoracic Surgery, Video-Assisted