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Management of malignant pleural effusion

Introduction Malignant pleural disease is a growing clinical problem and often results in substantial breathlessness for patients due to the accumulation of malignant pleural effusion. Dedicated pleural services are becoming more prevalent and a wider selection of treatment strategies are now available. This thesis evaluates a number of different aspects relating to the prognostication and treatment of patients with malignant pleural disease through a series of 4 studies. Methods The first study uses data from three, international, prospectively collected databases of patients with malignant pleural effusion to evaluate factors that predict patients' survival. From this data, the LENT prognostic score is developed and validated to assist clinicians in risk stratifying patients and thereby helping them to select appropriate treatment strategies. The second study is a systematic review of the literature, evaluating all the published randomised controlled trial (RCT) data on the management of malignant pleural effusion using network meta-analysis. These results highlight the efficacy of talc poudrage in obtaining a pleurodesis, but also emphasise the heterogeneity of the available evidence and the paucity of robust data on symptom based outcomes and adverse effects. The Zoledronic Acid (ZA) Trial is a pilot, RCT evaluating whether intravenous ZA is an effective potential treatment for MPE. In this small, diverse cohort, no significant difference was seen in the radiology, biomarkers or symptoms of the ZA group compared with those who received placebo. Finally, the SMART trial is a multi-centre RCT, evaluating the role of prophylactic radiotherapy in mesothelioma. 203 patients have been recruited to the study, which is currently in follow up and the results are awaited in winter 2015. Discussion This thesis adds to our understanding regarding the prognostication and management of patients with malignant pleural disease. The data will help to inform clinicians and future research studies regarding the optimal management of these patients
Date January 2015
CreatorsClive, Amelia Olga
PublisherUniversity of Bristol
Source SetsEthos UK
Detected LanguageEnglish
TypeElectronic Thesis or Dissertation

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