The largest study yet of mesothelioma patients with metastatic disease along the path of their lung catheters has some reassuring news for patients. Australian researchers find that the problem is usually treatable.
Many later-stage mesothelioma patients have indwelling pleural catheters put in place to help them deal with pleural effusions, a buildup of fluid that is a common symptom of the cancer. Untreated pleural effusions in mesothelioma can cause severe chest pain, shortness of breath, coughing and other life-limiting problems.
For mesothelioma patients who are not candidates for pleurodesis, studies have shown that the installation of a catheter to drain off the lung fluid can create other problems.The most serious problem associated with indwelling pleural catheters (IPCs) is the risk that mesothelioma will spread or metastasize along the pathway of the catheter. Some studies have suggested the problem may occur in more than 6% of IPC patients.
A study conducted at Sir Charles Gairdner Hospital and the University of Western Australia in Perth and published recently in the journal Chest finds that, although the problem “remains a clinical concern”, it typically causes only mild symptoms for mesothelioma patients and responds well to treatment with radiotherapy. The study involved 107 patients with either mesothelioma or another type of metastatic cancer that had IPCs placed for pleural effusions.
The study found that metastatic cancer developed in ten percent of cases, including nine of the mesothelioma patients and two with other kinds of cancer. The problem typically cropped up late – a median of 280 days after catheter insertion – and researchers found that the longer the interval after catheter insertion, the higher the risk that mesothelioma would spread to the catheter site.
The good news from the study was that six of the study subjects received palliative radiotherapy directed at the site of the metastatic mesothelioma (or other cancer) and the researchers report that the therapy was well-tolerated and effective. Lead author Rajesh Thomas, FRACP, writes, “Symptoms are generally mild and respond well to radiotherapy that can be administered safely without removal of the catheter.”
Previous studies have found that more than 90 percent of mesothelioma patients will eventually develop pleural effusions.
Thomas, R, et al, “Catheter Tract Metastasis Associated with Indwelling Pleural Catheters”, March 27, 2014, Chest, Epub ahead of print “Multicentre Study Comparing Indwelling Pleural Catheter with Talc Pleurodesis for Effusion Management”, ClinicalTrials.gov