Dear Cancer Grace,
My father has an adenocarcinoma stage 4 NSLC, on his right side there is a malign pleural effusion, his lung is trapped and he had one failed pleurodesis. He was diagnosed one year ago, and has not undergone second line therapy, yet. Right now he is in the hospital due to complications with the effusion. He had maybe 2,5 liters in the lung and became sick and had dyspnoea. They found out, that there was an infection in the pleura - maybe because of repeated drainage. They inserted a mechanical pump, which is pumping 500 ml from his effusion every day. He is feeling a bit better. But: they tried to treat him with antibiotics in order to minimize the effusion, but the antibiotics didn\'t work - so know they are trying to find out which antibiotics work -and they are considering cleaning the pleural space intrapleural with antibiotics.
I have to questions:
Firstly: He has a kind of potbelly and he still has dyspnoea even though he gets oxygen. I am wondering
if the mechanical pump is creating a kind air vaccum in the pleural space and is even pressing against the left lung - thereby inhibiting his breathing? Is the air going to leave, when he gets a manual drainage system?
They gave him three options, as soon as the rebuilding of fluid has minimized:
Surgery:Pleurectomy, doing nothing and inserting a drainage. Everything in combination with chemo.
I have however read about clinical trials where they tried intrapleural therapy with urokinase for people with trapped lung. Is this a clinical practice or still part of clinical trials?
I know you can\'t say what kind of treatment would be best for him. But maybe you could give some suggestions, which we could ask the doctor.
Kind regards
Malte
Reply # - January 30, 2014, 10:21 PM
Reply To: pleural effusion urokinase treatment?
I must confess I don't quite understand your question about inhibiting his breathing, but I would have to say that I don't think that needs to be a significant concern at all. At worst, draining the fluid won't help much, but it often does. I can't recall a situation in which it made things worse than they were at the start.
Urokinase wouldn't be a standard clinical practice, and I can recall just a single patient in the last 5-10 years in which the thoracic surgeons recommended it. I suspect that's because it's not especially helpful in the clear majority of patients, but I'll try to find out more when speaking with a thoracic surgeon in the next few days.
Also, with regard to the options, I think it's a very individualized situation that could be best addressed by the docs there, but I'd be concerned that a PleuRx catheter (drain) is often ineffective if the fluid is loculated (sitting in small pockets caused by scarring, as often happens after a failed pleurodesis) and/or infected, and having a catheter in with an active infection could make things worse. The surgeons will often do an open procedure to clean things out, and I suspect a pleurectomy might well be the most helpful approach.
Good luck.
-Dr. West
Reply # - January 31, 2014, 01:10 PM
Reply To: pleural effusion urokinase treatment?
Dear Dr. West,
thank you for the quick answer! I am sorry I couldn't explain the issue about the breathing more accurate. My english skills, especially regarding medical issues, are sometimes a bit limited. I would really like to hear what the thoracic surgeon has to say about urokinase, if she/he has something to say. It seems to me, as if our doctors are waiting a bit and still discussing about other options.
Kind regards
Malte