Chest
Volume 146, Issue 3, September 2014, Pages 557-562
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Original Research: Pulmonary Procedures
Catheter Tract Metastasis Associated With Indwelling Pleural Catheters

https://doi.org/10.1378/chest.13-3057Get rights and content

BACKGROUND

Indwelling pleural catheters (IPCs) are commonly used to manage malignant effusions. Tumor spread along the catheter tract remains a clinical concern for which limited data exist. We report the largest series of IPC-related catheter tract metastases (CTMs) to date, to our knowledge.

METHODS

This is a single-center, retrospective review of IPCs inserted over a 44-month period. CTM was defined as a new, solid chest wall lesion over the IPC insertion site and/or the tunneled subcutaneous tract that was clinically compatible with a malignant tract metastasis.

RESULTS

One hundred ten IPCs were placed in 107 patients (76.6% men; 60% with mesothelioma). CTM developed in 11 cases (10%): nine with malignant pleural mesothelioma and two with metastatic adenocarcinoma. CTM often developed late (median, 280 days; range, 56-693) post-IPC insertion. Seven cases had chest wall pain, and six received palliative radiotherapy to the CTM. Radiotherapy was well tolerated, with no major complications and causing no damage to the catheters. Longer interval after IPC insertion was the sole significant risk factor for development of CTM (OR, 2.495; 95% CI, 1.247-4.993;P= .0098) in the multivariate analyses.

CONCLUSIONS

IPC-related CTM is uncommon but can complicate both mesothelioma and metastatic carcinomas. The duration of interval after IPC insertion is the key risk factor identified for development of CTM. Symptoms are generally mild and respond well to radiotherapy, which can be administered safely without removal of the catheter.

Section snippets

Materials and Methods

All patients who had IPC insertion for MPE in our service were entered prospectively into a database, which was interrogated for the period of July 31, 2009, to February 28, 2013. All IPCs were inserted using standard procedures involving a modified Seldinger approach and subcutaneous tunneling. In our center, patients were instructed to perform pleural drainage via the IPC whenever they became symptomatic. CTM cases were captured through review of individual medical records and available

Results

During the study period, 107 patients underwent insertion of 110 IPCs (Rocket Medical plc) for MPE management (Table 1). One patient had IPCs inserted bilaterally, another had two IPCs inserted into separate collections on the same side, and one had IPCs inserted sequentially on the same side. For the purpose of data analysis, individual IPC insertions (n = 110) rather than individual patients were used. Mesothelioma was the commonest underlying malignancy (60%). No patient received

Discussion

This is the largest reported series of IPC-related catheter tract metastases to our knowledge. We showed that CTM could occur particularly, but not exclusively, in patients with mesothelioma, and often causes pain. Radiotherapy is effective and can be delivered safely with the catheter in situ. Our study showed that the duration after IPC placement is the most significant and sole predictor for development of CTM.

IPCs are increasingly used in the management of MPEs worldwide, and their benefits

Conclusions

In summary, clinicians using IPC should be aware of CTM, especially as a late complication, in patients with mesothelioma and metastatic malignancies. Patients should be educated to report early lesions. Radiotherapy appears effective, and removal of IPC is unnecessary.

Acknowledgments

Author contributions: Y. C. G. L. is guarantor of the study. R. T. and Y. C. G. L. contributed to conception and design of the study, pleural data collection, and drafting, revision, and final approval of the manuscript; C. A. B. contributed to statistical analyses and drafting, revision, and final approval of the manuscript; Y. J. K. contributed to imaging analyses and drafting, revision, and final approval of the manuscript; C. R. and E. T. H. F. contributed to pleural data collection and

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FUNDING/SUPPORT: Drs Fysh and Lee have received research grant support from the Sir Charles Gairdner Research Foundation, Cancer Council of Western Australia, Lung Institute of Western Australia (LIWA) Westcare, and the Dust Disease Board of New South Wales, Australia. Dr Lee is a recipient of a National Health and Medical Research Council (NH&MRC) Career Development Fellowship. Dr Thomas has received research scholarship support from NH&MRC, Western Australia Cancer and Palliative Care Network (WACPCN), and LIWA, Australia.

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