New German S3 guideline on lung cancer:
Role of IPCs in malignant pleural effusion
In Germany, the S3 guideline “Prevention, Diagnosis, Treatment and Follow-up of Lung Cancer” has been updated. The current version 5.1 contains important recommendations and scientific evidence on the treatment of recurrent symptomatic malignant pleural effusion and further strengthens the role of the indwelling, tunnelled pleural catheter (IPC).
The choice of treatment should be made on an individual basis. In addition to patient preference, general condition and life expectancy, the guideline takes particular account of lung expandability and any planned systemic therapy in the near term.
In addition, the current German guideline addresses the evidence on daily drainage and emphasises the importance of independent drainage in the home-care setting.
The IPC is therefore an integral part of guideline-based treatment in Germany for patients with lung cancer and recurrent symptomatic malignant pleural effusion.
Would you like to use IPCs in your hospital or optimise existing workflows? We support you with implantation, discharge management and outpatient follow-up care.
The IPC in the current German S3 guideline: key statements
1. IPC with systemic therapy
If systemic therapy is planned in the near term, an IPC should be considered regardless of lung expandability.
2. IPC for trapped lung
If the lung is non-expandable, an IPC should be used.
3. Shorter hospitalisation
The IPC enables independent drainage and reduces hospital stays and further pleural interventions.
4. Daily drainage
Daily drainage has been shown to increase the rate of spontaneous pleurodesis.
1. IPC when systemic therapy is planned in the near term
If chemotherapy or immunotherapy is planned in the near term, an IPC should be considered regardless of lung expandability. The German guideline takes into account possible side effects or delays associated with talc pleurodesis.
2. Non-expandable lung (trapped lung)
In recurrent symptomatic malignant pleural effusion with a non-expandable lung – trapped lung – an indwelling, tunnelled pleural catheter should be implanted.
3. Independent drainage and shorter hospitalisation
The current German guideline refers to two randomised studies comparing IPC with talc pleurodesis in malignant pleural effusion.
The IPC enables repeated, independent drainage of malignant pleural effusion both in hospital and in the home-care setting.
IPC and talc pleurodesis provide comparable symptom relief. Studies show, however, that IPC is associated with shorter hospital stays and fewer subsequent invasive pleural interventions. It therefore supports earlier outpatient care and can reduce the number of inpatient treatment days.
TIME2-Studie
Auch die AMPLE-2-Studie zeigte bei täglicher Drainage gegenüber einer symptomorientierten Drainage häufiger eine Spontanpleurodese:
37,2 % gegenüber 11,4 % nach 60 Tagen.
In der Studie war zudem die Lebensqualität in der Gruppe mit täglicher Drainage höher. Bei Hospitalisierungsdauer, Letalität und Komplikationsrate zeigten sich keine signifikanten Unterschiede.
TIME2 study
The TIME2 study compared IPC with chest tube drainage and talc pleurodesis. Both treatments provided comparable relief of dyspnoea during the first 42 days.
IPC: 3,5 days shorter initial hospital stay.
In addition, fewer patients required a further pleural intervention: 6% in the IPC group compared with 22% in the talc pleurodesis group.
AMPLE study
The AMPLE study also compared IPC with talc pleurodesis. Patients with an IPC spent fewer days in hospital during the subsequent course of their disease.
IPC: 2 days less in hospital
Overall hospitalisation was therefore significantly shorter with IPC. The difference was particularly pronounced for effusion-related hospital stays: one day with IPC compared with four days with talc pleurodesis. Further invasive pleural drainage procedures were also required less frequently with IPC: 4.1% of patients with IPC required a repeat intervention, compared with 22.5% after talc pleurodesis.
4. Daily drainage promotes spontaneous pleurodesis
The current German guideline refers to two randomised studies that investigated different drainage intervals after IPC implantation.
ASAP study
In the ASAP study, spontaneous pleurodesis was achieved significantly more often with daily drainage than with drainage every other day:
47% with daily drainage compared with 24% with drainage every other day.
AMPLE-2 study
The AMPLE-2 study also showed a higher rate of spontaneous pleurodesis with daily drainage compared with symptom-guided drainage:
37,2% with daily drainage compared with 11.4% with symptom-guided drainage.
In the study, quality of life was also higher in the daily drainage group. There were no significant differences in duration of hospitalisation, mortality or complication rates.
IPC solutions for different requirements
ewimed offers a range of indwelling, tunnelled catheters for the drainage of pleural effusions. This allows the system to be selected according to the clinical situation and the intended care pathway.
Would you like to use IPCs in your hospital or optimise existing workflows? We support you with implantation, discharge management and outpatient follow-up care.
drainova® ArgentiC S catheter
The drainova® ArgentiC S was developed specifically with mobile and active patients in mind.
It combines the proven features of drainova® catheters with a shortened extracorporeal design and a compact, flat dressing. For greater discretion, freedom of movement and easy handling in everyday life.
drainova® ArgentiC catheter
The drainova® ArgentiC is the proven catheter solution with micro silver technology for recurrent drainage of pleural effusion and ascites.
It combines reliable use with easy handling and supports care in both home-care and inpatient settings.
PleurX™/PeritX™ catheter
PleurX™ and PeritX™ catheters are proven catheter solutions for recurrent drainage in the home-care setting.
PleurX™ is used for the drainage of pleural effusion, while PeritX™ is specifically intended for the drainage of ascites. Both are easy to handle and support independent care at home.
- Sources and further information
- Guideline Programme in Oncology: S3 guideline “Prevention, diagnosis, treatment and follow-up of lung cancer”, long version 5.1, July 2026, AWMF registry number 020-007OL. View online version | Open PDF
- Wahidi MM et al. Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial. Am J Respir Crit Care Med. 2017;195(8):1050–1057.
- Muruganandan S et al. Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial. Lancet Respir Med. 2018;6(9):671–680.
- Oncology S3 guidelines as an app