Soft tissue sarcoma metastatic to pleura

Malignant pleural effusion (MPE) is a common complication of advanced cancer. The presence of MPE eliminates the possibility of radical cancer treatment, but palliative care plays an important role for these patients. Chemical pleurodesis is one of the options to avoid development of recurrent pleural effusions and thus palliate symptoms (2). In order pleurodesis to be successful, MPE should be drained by serial thoracentesis or chest tube insertion to achieve complete lung re-expansion. Regardless of the volume of pleural space drainage, pleurodesis should be carried out as soon as the condition is diagnosed by chest roentgenogram because inflammation induced by pleurodesis would cause the parietal and visceral layers of the pleura to adhere, and the space would disappear, only when they come into close contact with each other. Sahn argued that patients are suitable candidates for pleurodesis if and when expected survival is at least several months, the patient is not debilitated, and the pleural fluid pH is ≥ 7.30. The author has also argued that pleural fluid pH < 7.30 not only suggests a short survival-time but also predicts a poor response to chemical pleurodesis (3). Moreover, fibrosis involving the pleural surfaces in the low-pH effusions diminishes the effectiveness of pleurodesis in producing pleural symphysis (4). In this case, the pleural fluid pH was 7.05 and complete apposition of the pleural surfaces had not been achieved despite fibrinolytic treatment. Therefore, the chance that this patient will benefit from pleurodesis is very little, if any.