I would love to here your experience. My 62-year-old husband was diagnosed in 10/2013 with adenocarcinoma based upon metastatic pleural effusion. He has has a thoracentesis approximately every two weeks (3 total) removing ~ 2800ml each time. Last one was 11/1/2013, and chemo started 11/8/2013 (clinical trial with carbo, taxol, Erbitux and bevacizumab. We are concerned about the volume of fluid, as each post procedure X-ray shows minimal change after drainage. I'm thinking we should ask the doc about implanting a drain rather than going through the stress each time when the shortness of breath becomes so severe that we need the tap. The doc said the chemo should dry up the effusion, but how quickly could that happen? We are coming up on another two-week interval in 4 days, and we are only 3 days into chemo. This is scary...
Recurrent Malignant Pleural Effusion - 1260451
suejg
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Reply # - November 11, 2013, 09:33 PM
Reply To: Recurrent Malignant Pleural Effusion
Hi Sue, Welcome to Grace. I'm very sorry about your husband's diagnosis. Yes, it's scary to say the least. Unfortunately like many answers to questions about nsclc it's not possible to do anything better than guess at when the chemo might dry up the PE. Maybe a month, or months. Your oncologist wants to give it a chance before moving to another procedure. Also his body will continue to react to the chemo between infusions including hopefully drying up the PE. But if action has to be taken a pleurx catheter or pleurodesis are common options. Dr. West has explained each of these in this post, http://cancergrace.org/lung/2007/03/18/mpe-managment-options/
I hope the chemo works. Keep us posted,
Janine
Reply # - November 12, 2013, 08:24 AM
Reply To: Recurrent Malignant Pleural Effusion
The timing of adding a PleuRx is always an open question. While it's very possible for the effusion to diminish and then stop as a manifestation of a response to chemo or other systemic therapy, that typically takes weeks to a few months, and it only happens in the patients who respond significantly to the treatment. I would estimate that to be about a third of patients. Because the PleuRx can be removed if the fluid is no longer being produced, at my center we usually err on the side of adding a PleuRx if it's needed and then remove it if a patient has a response good enough that they no longer need it. That said, an interval between thoracenteses of every two weeks is not that short, so we wouldn't really rush to place a PleuRx for an effusion that would only potentially need to be tapped 1-2 more taps before we could expect to see whether the chemo is leading to a response or not.
Good luck.
-Dr. West
Reply # - November 12, 2013, 08:24 AM
Reply To: Recurrent Malignant Pleural Effusion
The timing of adding a PleuRx is always an open question. While it's very possible for the effusion to diminish and then stop as a manifestation of a response to chemo or other systemic therapy, that typically takes weeks to a few months, and it only happens in the patients who respond significantly to the treatment. I would estimate that to be about a third of patients. Because the PleuRx can be removed if the fluid is no longer being produced, at my center we usually err on the side of adding a PleuRx if it's needed and then remove it if a patient has a response good enough that they no longer need it. That said, an interval between thoracenteses of every two weeks is not that short, so we wouldn't really rush to place a PleuRx for an effusion that would only potentially need to be tapped 1-2 more taps before we could expect to see whether the chemo is leading to a response or not.
Good luck.
-Dr. West
Reply # - November 12, 2013, 02:07 PM
Reply To: Recurrent Malignant Pleural Effusion
Thank you both for this very helpful information. I truly appreciate your responses. It's scary to see my husband get to the point where he has difficulty breathing and then have almost 3000 ml drained with barely a change on the post procedure x-ray. It's scary for him too, but it sounds like it is in his best interest to wait to have a thoracentesis when he experiences difficulties rather than trying to prevent them. I hate that this is happening to him - to us... I don't want to sit back and let the cancer take us - I want to fight it, but I have so few weapons. Thank you for being there.
Reply # - November 13, 2013, 11:32 AM
Reply To: Recurrent Malignant Pleural Effusion
Sue, if you think it will help, read up on the most recent practices here on Grace and ask questions when they arise. If your head and heart respond like some of us who frequent Grace you'll feel more in control and not feel so under-powered. For me to have an understanding of how things work, good or bad has a calming effect some people prefer to deny and go with the flow. My husband is the latter and while not always easy we make it work and even his oncologist knows how to work with our very different personalities.
It's as important to know when to hold treatment as it is to know when to use it. Think of it as a marathon; you want to run for as long as possible so will need to reserve your resources for as long as possible. The analogy works in many areas of your life right now. Take care of yourself as well as your husband. It's likely the most difficult time you've ever experienced yet you want it to last for as long as possible; I've found that thought impossible reconcile so I don't try. Just know there are many people who live life that way.
Janine
Reply # - November 14, 2013, 05:11 AM
Reply To: Recurrent Malignant Pleural Effusion
Thank you, Janine. I will continue to read, study and participate in groups, hoping to gain more knowledge of my husband's situation and what is best for him. You are right that, personally, I feel more empowered by a better understanding of how things work, and that alone does have somewhat of a calming effect. Thanks again.