Pleurodesis: The agent of choice

A malignant pleural effusion usually signifies advanced metastatic disease and is associated with a poor prognosis with median survival between 3 and 12 months, depending on the primary site. Optimal management of these effusions has been debated over the years. Management choices include repeated therapeutic aspiration alone, for patients at the very end of life, chest tube drainage with chemical pleurodesis, thoracoscopic drainage and talc poudrage, or placement of an indwelling pleural catheter (IPC). Most of us would agree that the ideal method should be effective, safe, inexpensive, readily available and should require a short or no hospital stay.