Malignant Pleural Effusion - Indwelling catheter vs. shunt? - 1250399

tlc2tlc
Posts:7

I don't have the full diagnosis, as I missed going to this doctor appointment with her, but my sister in law saw her lung doctor Friday, and he said her left lung (where primary tumor is) is no longer working. I don't know if that means trapped lung or what. She had an indwelling catheter put in back in August due to the high amount of fluid accumulating daily, and is using the Pleurx bottles to drain daily. He asked if she'd had a CT scan lately, which she has, so he said he would follow up with her oncologist. He mentioned possibly going to a shunt.

I see the shunts have higher incidence of blockage, infection, and allow "tumor seeding" where moving that fluid into the peritoneal space could create tumor growth in other areas.

She was diagnosed in August w/ Stage IV NSCLC Adeno ALK+, has had one chemo session of Carbo/Alimta after failing on crizotinib after 7 weeks. She's averaging 350-500ml fluid daily. Mets to bones and now the liver as of last scan 10 days ago.

What are the pros/cons of going to a shunt, versus the indwelling catheter?

Thank you,
tlc2tlc

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Reply # - November 19, 2012, 07:33 AM

Dr Pennell
Posts: 139

Hi tlc2tlc,

I am not certain what your sister's oncologist is referring to in this situation. It would be very unusual to place a pleural-peritoneal shunt in someone with ongoing malignant (cancerous) effusion for the very reasons that you pointed out: it can get clogged and would be hard to get to to fix, the cancer can spread to the peritoneum which is very serious, and ascites (fluid in the abdomen) is not a very pleasant thing to have. It is not unusual to have persistent drainage from a pleurex catheter, so generally patients just continue to drain the pleurex as needed.

Half a liter per day is quite a lot and she would need to make sure she isn't getting dehydrated, but there really isn't a very good alternative. The best treatment is really to find an effective treatment for her cancer, which I sincerely hope her doctor is able to do, but in the meantime it sounds like the pleurex is doing the job it is supposed to do. Please let me know if I misunderstood and there is something specific about the drain that is not working properly.

Reply # - November 19, 2012, 10:59 AM

tlc2tlc
Posts: 7

Thank you Janine and Dr. Pennell for your replies.

It was her lung dr. that mentioned the shunt after looking at her x-ray on Friday, not her oncologist. To be honest, I've not been real pleased w/ the lung dr. so far. First office trip we made after discharge from the hospital, several people saw her, and not one auscultated her lungs! She had an x-ray at that time, and another this last Friday. I'm not sure what the dr. saw, unfortunately my sister in law doesn't ask a lot of specific questions, but whatever it was concerned him, and he said he would follow up w/ her oncologist, and mentioned the possibility of putting in a shunt.

Her oncologist, on the other hand, we have been thrilled with! From the research I've been able to do, he is right on track with treating her as he should. He was extremely disappointed that her cancer progressed to her liver while on crizotinib, her first CT scan at 3 weeks on crizotinib had shown "marked improvement" in her lungs. She is now on the Carboplatin/Alimta chemo, had one treatment so far, last Thursday, a day before the lung dr. appt., and she did great. The catheter so far has been working great, only got semi-clogged back in September, but that resolved itself after a few days without intervention.

She didn't get specifics on what he meant by her left lung "not working" anymore, I don't know if that means not expanding anymore, or what. Would that change the effectiveness of the pleurx catheter? If not, I don't see the need for more invasive interventions, and thank you for your view on that. I will be sure to ask lots of questions when we see her oncologist tomorrow.

tlc2tlc

Reply # - November 19, 2012, 12:51 PM

Dr Pennell
Posts: 139

It may well be that her lung did not re-expand when the fluid was drained, that is unfortunately relatively common and might explain why the lung is "not working", but a shunt wouldn't fix that any more that the pleurex did. I am glad to hear she is tolerating the chemo well, I sincerely hope it helps!

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