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Chest. 2014 Sep;146(3):557-562. doi: 10.1378/chest.13-3057.

Catheter tract metastasis associated with indwelling pleural catheters.

Author information

1
Department of Respiratory Medicine, Sir Charles Gairdner Hospital; School of Medicine and Pharmacology, University of Western Australia; Lung Institute of Western Australia, Perth, WA, Australia.
2
Department of Research, Sir Charles Gairdner Hospital.
3
Department of Radiology, Sir Charles Gairdner Hospital.
4
Lung Institute of Western Australia, Perth, WA, Australia.
5
School of Medicine and Pharmacology, University of Western Australia; Centre for Applied Statistics, University of Western Australia; Lung Institute of Western Australia, Perth, WA, Australia.
6
Department of Radiation Oncology, Sir Charles Gairdner Hospital.
7
Department of Respiratory Medicine, Sir Charles Gairdner Hospital; School of Medicine and Pharmacology, University of Western Australia; Centre for Applied Statistics, University of Western Australia; Lung Institute of Western Australia, Perth, WA, Australia. Electronic address: gary.lee@uwa.edu.au.

Abstract

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.

PMID:
24676503
DOI:
10.1378/chest.13-3057
[Indexed for MEDLINE]

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