Management of malignant pleural effusion

Malignant pleural effusion is a frequent cause of morbidity in cancer patients. Pleural aspiration relieves dyspnoea usually only for a matter of days, and if the tumour type is not chemosensitive, some form of pleurodesis is commonly required. Tube thoracostomy is widely used to achieve pleural drainage prior to attempting pleurodesis by instillation of a variety of 'sclerosants'. Recently thoracoscopic instillation of talc has been advocated and some authors report high rates of fluid control. Randomised trials comparing this approach compared to tube thoracostomy and chemical pleurodesis are required.