MANAGEMENT OF MALIGNANT PLEURAL EFFUSIONS

Malignant pleural effusions (MPEs) represent a common complication of advanced malignancies. However, adequate palliation of this highly sym ptomatic accompaniment to cancer can be achieved in most patients by a dopting the appropriate therapy. Several options are available for the treatment of MPE. Systemic therapy may control the effusion in patien ts whose underlying malignancy is sensitive to anticancer agents. Repe ated thoracocentesis can be appropriate for patients with limited life expectancy or slowly recurrent effusions. In the majority of the rema ining cases the treatment of choice is pleurodesis with sclerosing age nts administered via tube thoracostomy. Controversy still exists as to which drug produces the best results: talc and bleomycin appear to be among the most cost-effective agents. The debate over the best agent to be used for pleurodesis refers to the difficulty in comparing resul ts of studies using different eligibility criteria, response assessmen t and end-points. This article describes the various treatments which have been reported in the literature to play a role in the management of MPEs. It is also aimed at providing guidelines in allocating patien ts to appropriate treatments.