From the Guidelines
Octreotide, a somatostatin analogue, plays a role in the conservative management of chylothorax as an adjunctive therapy.
Management of Chylothorax
- The goal of treatment is to reduce the production of chyle and consequently flow through the thoracic duct.
- Conservative measures include management of the underlying disease, thoracentesis, and dietary modifications such as total parenteral nutrition or a nonfat diet.
- Adjunctive therapy may include somatostatin analogues like octreotide, etilefrine, or nitric oxide, with the underlying etiology determining the efficacy, although the evidence remains scarce 1.
Role of Octreotide
- Octreotide may be used to reduce chyle production, although its effectiveness is not well established, particularly in neoplastic etiologies.
- The success of conservative therapy, including octreotide, approaches 50% in nonmalignant etiologies but is only minimally beneficial in neoplastic etiologies 1.
Invasive Treatment Options
- Invasive treatments, such as surgical thoracic duct ligation, pleurodesis, and thoracic duct embolization (TDE), may be considered if conservative treatment has not resolved the chylothorax after 2 weeks, in higher-output chylothoraces, and in underlying neoplastic etiologies 1.
The FDA Drug Labels for octreotide (IV) do not address this question.
From the Research
Role of Octreotide in Chylothorax Management
The use of octreotide, a somatostatin analogue, has been explored in the management of chylothorax, a condition characterized by the leakage of lymphatic fluid into the thoracic cavity. Key findings from various studies include:
- Octreotide has been shown to be effective in reducing chylothorax volume, especially in patients with higher output chylothorax (>40 ml/kg/h) after the failure of conservative management 2.
- The mechanism of action of octreotide in chylothorax management is unclear, but it is thought to involve a decelerating effect on lymph flow 3.
- Studies have reported significant reductions in fluid losses and postoperative length of stay with the use of octreotide in patients with postoperative chylothorax 4, 5.
- Octreotide has been used successfully in the treatment of malignant chylothorax, with improvements in symptoms, quality of life, and length of hospital stay 6.
- The general consensus is for conservative management with octreotide to be instituted for 1 week before consideration of surgery, although some authors have advocated for earlier surgical intervention in cases of large volume chylothorax 5.
Efficacy and Safety of Octreotide
The efficacy and safety of octreotide in chylothorax management have been demonstrated in several studies, including:
- A study of 8 patients with postoperative chylothorax, which found that octreotide reduced total fluid losses and postoperative length of stay compared to conventional management 4.
- A review of 19 papers on the use of octreotide in chylothorax, which found that 16 papers reported octreotide to be effective in reducing lymphorrhagia 5.
- A case report of a patient with malignant chylothorax, which found that subcutaneous octreotide treatment resulted in significant improvements in symptoms and quality of life 6.
Limitations and Future Directions
While the available evidence suggests that octreotide is a useful adjunct treatment in chylothorax management, there are several limitations to the current research, including: