Shortness of Breath Treatment Can ‘Seed’ New Mesothelioma Tumors

Mesothelioma patients who get pleural catheters to help with shortness of breath may pay a high price.

New research shows about a quarter of them will develop new mesothelioma tumors at the spot where the catheter was placed.

In a newly published paper, Canadian researchers say doctors need to consider the possibility of these catheter tract metastases (CTMs) when advising mesothelioma patients.

Indwelling Pleural Catheters and Mesothelioma

Many mesothelioma patients develop excess fluid around their lungs. This fluid puts pressure on the lungs and makes it hard for patients to get a deep breath. Shortness of breath is a common symptom of pleural mesothelioma.

Indwelling pleural catheters (IPCs) can help. An IPC is a little tube inserted into the pleural lining where the fluid is.

The job of an IPC is to relieve pressure around the lung by allowing lung fluid to drain out. An IPC stays in place and can be drained by the patient or a caregiver.

According to the article in the European Respiratory Journal, eight out of ten patients who got an IPC had less shortness of breath.

The Downside of IPCs for Shortness of Breath

But there is a downside to using IPCs to relieve mesothelioma shortness of breath. These tubes can spread mesothelioma cells. When new mesothelioma tumors spring up where the IPC was inserted it is called catheter tract metastasis (CTM).

The Canadian team reviewed the cases of 90 mesothelioma patients who had IPCs at their hospital. This is the largest study of CTM in mesothelioma patients. Twenty-four of them (26.7%) developed CTM after the catheter was removed.

“Our data indicates CTM occurs in over a quarter of patients receiving IPCs and is higher than previously reported,” writes researcher Sarah Hosseini. “Treating physicians should be cognizant of the possibility of CTM at the site of prior IPC.”

It took an average of 457 days for new mesothelioma tumors to show up. Mesothelioma patients who got IPCs faced the same risk for new tumors, no matter what type of mesothelioma they had.

Can New Mesothelioma Tumors be Prevented?

The new study does not address treatment of CTMs but other studies have. Some suggest that radiotherapy before the procedure might prevent CTMs and improve survival.

But the jury is still out on that idea. A 2016 UK study found there was no advantage to doing radiotherapy in advance.

In that study, mesothelioma patients had the same outcomes whether they were treated as soon as their IPC was removed or after tumors cropped up.

The authors of the current report say it is an issue that “requires revisiting”.

Source:

Hosseini, S, et al, “Catheter tract metastasis in mesothelioma patients with indwelling pleural catheters”, European Respiratory Journal, Vol 52, Issue suppl 62, 2018, http://erj.ersjournals.com/content/52/suppl_62/PA3379