Westley, R., De Fonseka, D. orcid.org/0000-0002-0060-9671 and Bedawi, E.O. (2025) Updates in the management of malignant pleural effusion: a clinical practice review. Journal of Thoracic Disease, 17 (8). pp. 6283-6295. ISSN: 2072-1439
Abstract
The presence of a malignant pleural effusion (MPE) confers a poor prognosis, with a high burden of disabling symptoms due to altered respiratory mechanics and abnormal diaphragm function. Management is often palliative in nature, with the emphasis on preventing fluid re-accumulation. In the era of targeted therapies, pleural biopsies are often required for gene expression and receptor status profiling, for which local anaesthetic thoracoscopy provides the highest diagnostic yield. Interventions to achieve symptom control include thoracentesis, chest drain insertion, indwelling pleural catheters, medical thoracoscopy and surgery. The evidence base for these interventions has historically been lacking with a somewhat linear pathway, however, numerous well-designed, multicentre randomised controlled trials over the last decade using patient-centred outcomes have informed recent clinical practice guidelines. Several therapeutic options and combinations now exist to achieve optimal symptom control and pleurodesis, centred around patient choice and priorities, inpatient versus outpatient strategies and the presence of non-expandable lung. This review will explore the data that has shaped MPE management in the last decade, with the aim of providing a deeper understanding of the rationale behind current international guideline recommendations. It will also highlight areas where the evidence base is lacking, research currently in progress and potential future directions.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2025 AME Publishing Company. This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non- commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/ |
Keywords: | Malignant pleural effusion (MPE); pleural disease; pleurodesis |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) |
Date Deposited: | 29 Sep 2025 14:26 |
Last Modified: | 29 Sep 2025 14:26 |
Status: | Published |
Publisher: | AME Publishing Company |
Refereed: | Yes |
Identification Number: | 10.21037/jtd-2025-113 |
Related URLs: | |
Sustainable Development Goals: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:232323 |