[Pathophysiology, incidence and therapy of malignant pleural effusion]

Malignant pleural effusions are a common and significant problem in patients with advanced malignancies. Effective control of recurrent malignant effusion can greatly improve the quality of life. On the basis of comparison involving, efficacy, toxicity, and costs we recommend intrapleurally tetracycline with chest tube drainage as the technique of choice inducing a response rate of 70%. Instillation of fibrin glue into the thoracic cavity through a tube is also a safe and effective technique and should be employed when tetracycline fails. Mediastinal radiation constitutes the best local therapy secondary to lymphoma. Pleurectomy would be appropriate in a very small subset of patients whose performance status is exceptionally good and whose malignancy ist otherwise under good control.