chemical pleurodesis for patients with longer expected survival or faster recurrent pleural effusion

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Although some patients with malignant pleural effusions may remain asymptomatic and do not need to be treated, many will develop symptoms associated with the effusion (eg, shortness of breath). Initial management of symptomatic patients consists of large-volume thoracentesis. If the effusion reaccumulates slowly and the patient has a very short expected survival, a repeated thoracentesis can be performed once symptoms recur. More aggressive intervention is required for patients in whom the effusion reaccumulates rapidly (eg, <1 month) or in those with a longer expected survival. In these cases, chemical pleurodesis is most appropriate, which consists of obliterating the pleural space by inducing pleural inflammation and fibrosis using a sclerosing agent (eg, talc). Placement of an indwelling pleural drainage catheter is another option but is associated with a higher rate of adverse events (eg, infection).