title: Management of malignant pleural effusions: questions that need answers.
abstract: OBJECTIVE
  Malignant pleural effusion (MPE) is common. However, regardless of the differences between patients, their underlying cancer type, and pleural fluid characteristics, management options are often limited. These have not advanced significantly over the last 80 years since pleurodesis was first described. Correspondingly, patient-related outcome measures have been neglected. The evidence (or lack of) behind the current treatment recommendations is reviewed and key research questions are described.
  
  
  RESULTS
  Talc continues to be the most effective sclerosant available for pleurodesis in MPE. A recent randomized controlled trial comparing talc pleurodesis and indwelling pleural catheter insertion as first-line therapy suggests these approaches are equally effective, and utilized a patient-based symptom score as the primary outcome. The need to acknowledge the advances in translational medicine and oncological therapies to measure patient-related trial outcomes and to target pleural fluid formation in MPE is discussed.
  
  
  CONCLUSIONS
  Pulmonologists should be aware of the staggering lack of progress in the evidence that supports the current 'recommended' management of MPE. The need for a re-think about MPE management with a focus on alternative therapeutic targets and treatment objectives should be appreciated, in order to optimize future patient care.
authors.affiliation: Department of Respiratory Medicine, University Hospital of Wales, Cardiff, UK.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Davies
authors.forename: Y C Gary
authors.initials: YC
authors.lastname: Lee
mesh_terms: D002404:Catheterization / Q000379:methods*; D002408:Catheters, Indwelling; D003362:Cost-Benefit Analysis; D003657:Decision Making; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015996:Survival Rate; D013627:Talc / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D012597:Sclerosing Solutions; D013627:Talc