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Background and Objective: Device‐assessed activity behaviours are a novel measure for comparing intervention outcomes in patients with malignant pleural effusion (MPE). Australasian Malignant PLeural Effusion (AMPLE)‐2 was a multi‐centre clinical trial where participants with MPE treated with an indwelling pleural catheter were randomized to daily (DD) or symptom‐guided (SGD) drainage for 60‐days. Our aim was to describe activity behaviour patterns in MPE patients, explore the impact of drainage regimen on activity behaviours and examine associations between activity behaviours and quality of life (QoL). Methods: Following randomization to DD or SGD, participants enrolled at the lead site (Perth) completed accelerometry assessment. This was repeated monthly for 5‐months. Activity behaviour outcomes were calculated as percent of daily waking‐wear time and compared between groups (Mann–Whitney U test; Median [IQR]). Correlations between activity behaviour outcomes and QoL were examined. Results: Forty‐one (91%) participants provided ≥1 valid accelerometry assessment (DDn = 20, SGD n = 21). Participants spent a large proportion of waking hours sedentary (72%–74% across timepoints), and very little time in moderate‐to‐vigorous physical activity (<1% across timepoints). Compared to SGD group, DD group had a more favourable sedentary‐to‐light ratio in the week following randomization (2.4 [2.0–3.4] vs. 3.2 [2.4–6.1]; p = 0.047) and at 60‐days (2.0 [1.9–2.9] vs. 2.9 [2.8–6.0]; p = 0.016). Sedentary‐to‐light ratio was correlated with multiple QoL domains at multiple timepoints. Conclusion: Patients with MPE are largely sedentary. Preliminary results suggest that even modest differences in activity behaviours favouring the DD group could be meaningful for this clinical population. Accelerometry reflects QoL and is a useful outcome measure in MPE populations. Accelerometry is a novel patient‐centred outcome measure. Malignant pleural effusion patients are mostly sedentary. Those undergoing daily drainages of indwelling pleural catheter could have a better activity behaviour profile compared to those doing symptom guided drainages. A lower proportion of sedentary time was associated with better quality of life. [ABSTRACT FROM AUTHOR]

Improved diagnostic biomarkers, biopsy methods and imaging techniques have all contributed to better patient safety. Imaging-guided pleural biopsy provided better diagnostic accuracy than "blind" closed pleural biopsy in a randomized study on suspected malignant pleural effusion (MPE)[4] and significantly reduced the need of thoracoscopic biopsies. Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion: the AMPLE randomized clinical trial. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. [Extracted from the article]

The approach to management of malignant pleural effusions ( MPE) has changed over the past few decades. The key goals of MPE management are to relieve patient symptoms using the least invasive means and in the most cost-effective manner. There is now a realization that patient-reported outcome measures should be the primary goal of MPE treatment, and this now is the focus in most clinical trials. Efforts to minimize patient morbidity are complemented by development of less invasive treatments that have mostly replaced the more aggressive surgical approaches of the past. Therapeutic thoracentesis is simple, effective and generally safe, although its benefits may only be temporary. Pleurodesis is the conventional and for a long time the only definitive therapy available. However, the efficacy and safety of talc pleurodesis has been challenged. Indwelling pleural catheter ( IPC) drainage is increasingly accepted worldwide and represents a new concept to improve symptoms without necessarily generating pleural symphysis. Recent studies support the effectiveness of IPC treatment and provide reassurance regarding its safety. An unprecedented number of clinical trials are now underway to improve various aspects of MPE care. However, choosing an optimal intervention for MPE in an individual patient remains a challenge due to our limited understanding of the underlying pathophysiology of breathlessness in MPE and a lack of predictors of survival and pleurodesis outcome. This review provides an overview of common pleural interventional procedures used for MPE management, controversies and limitations of current practice, and areas of research most needed to improve practice in future. [ABSTRACT FROM AUTHOR]

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Background: Transforming growth factor (TGF)-β2 can produce effective pleurodesis in animals, but its efficacy has not been compared with commonly used pleurodesing agents in sheep, which have a thick pleura resembling that of humans. The acute physiological effects and the level of systemic TGF-β absorption after its intrapleural administration have not been studied. The aims of the present study were to compare: (i) the effectiveness of TGF-β2, talc and bleomycin in producing pleurodesis in sheep; (ii) the acute side-effects and systemic TGF-β levels following the intrapleural administration of these agents; and (iii) histological changes after intrapleural injections of these agents. Methodology: Twelve sheep were divided into three groups and were given a single intrapleural dose of TGF-β2 (0.25 μg/kg), talc slurry (5 g) or bleomycin (60 IU) via a chest tube. Saline or buffer was injected into the contralateral side, which served as the control. Arterial blood gases and respiratory and heart rates were monitored for the first 24 h. Plasma levels of TGF-β1 and TGF-β2 were measured. Pleurodesis was graded macroscopically from 1 (none) to 8 (symphysis > 50% of hemithorax) at day 14. Results: At day 14, the pleurodesis score of the TGF-β2 group (7.7 ± 0.6) was similar to that of the talc (7.0 ± 1.7) group and significantly higher than that of the bleomycin group (3.3 ± 2.3; P < 0.05). No significant differences were seen in arterial blood gas analysis, vital signs and plasma TGF-β1 and TGF-β2 concentrations among the three groups. Conclusions: Transforming growth factor-β2 was as effective as talc and more so than bleomycin in inducing pleurodesis in sheep. Intrapleural administration of TGF-β2 appeared safe. No acute changes in gaseous exchange or macroscopic abnormalities were seen following intrapleural TGF-β2. Importantly, there was no evidence of an increase in systemic... [ABSTRACT FROM AUTHOR]

Background: We have recently demonstrated that transforming growth factor beta-2 ( TGF-β2 ) can produce effective pleurodesis. Whether this effect can be reproduced by the use of its downstream proteins is not known. This study compared the effectiveness of TGF-β2 and fibronectin in inducing pleurodesis in rabbits. Methodology: New Zealand white rabbits (1.5–2.0 kg) were given 1.7 μg of TGF-β2 (n = 5) or 2.0 mg of cellular fibronectin (n = 4) intrapleurally via a chest tube. The induced pleural fluid was collected and analyzed. The rabbits were sacrificed after 14 days. The pleurodesis was graded macroscopically from 1 (none) to 8 (symphysis > 50%). Results: All rabbits in the TGF-β2 group developed effective pleurodesis while none in the fibronectin group had scores > 2 (pleurodesis scores 7.0 ± 0.6 vs 1.3 ± 0.3, P < 0.001). Rabbits that received TGF-β2 produced large amounts of pleural fluid initially (< 4 days). Microscopically, the pleura of rabbits in the TGF-β2 group showed prominent spindle cell proliferation and collagen deposition, but no significant inflammation or mesothelial proliferation. Pleural tissues of rabbits in the fibronectin group had occasional thin collagen deposits only. The intrapleural administration of 2.0 mg of fibronectin, a downstream product of TGF-β, did not induce effective pleurodesis, as did the intrapleural administration of TGF-β2 . Conclusions: The present study suggests that the mechanism by which TGF-β2 induces pleurodesis is not predominantly dependent on the production of fibronectin. [ABSTRACT FROM AUTHOR]