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      ERS/EACTS statement on the management of malignant pleural effusions

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          Abstract

          <p class="first" id="d4930387e275">Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.Management options for malignant pleural effusions have advanced over the past decade, with high-quality randomized trial evidence informing practice in many areas. However, uncertainties remain and further research is required http://ow.ly/rNt730jOxOS. </p>

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          Author and article information

          Journal
          European Journal of Cardio-Thoracic Surgery
          Oxford University Press (OUP)
          1010-7940
          1873-734X
          January 2019
          January 01 2019
          July 27 2018
          January 2019
          January 01 2019
          July 27 2018
          : 55
          : 1
          : 116-132
          Affiliations
          [1 ]Academic Respiratory Unit, University of Bristol Medical School Translational Health Sciences, Bristol, UK
          [2 ]North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
          [3 ]Division of Thoracic Surgery, University Hospital Bern, Bern, Switzerland
          [4 ]Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
          [5 ]Pleural Medicine Unit, Arnau de Vilanova University Hospital, IRB Lleida, Lleida, Spain
          [6 ]Department of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
          [7 ]Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
          [8 ]Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
          [9 ]Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
          [10 ]Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
          [11 ]Pulmonary and Thoracic Oncology Department, Hospital of the University (CHU) of Lille, Lille, France
          [12 ]Oxford Centre for Respiratory Medicine, University Hospitals, NHS Foundation Trust, Oxford, UK
          [13 ]Task force chairperson
          [14 ]Department of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
          Article
          10.1093/ejcts/ezy258
          30060030
          7c4f4fff-80ce-4c6d-9232-c6cd11feedd1
          © 2018

          https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

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