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Evidence‐based approaches

Principles of care

Several methods have been used to treat pleural effusions, including:
  • surgical techniques, such as ablation of the pleural space
  • radiotherapy
  • systemic chemotherapy
  • the insertion of a small‐bore catheter and installation of a pleural shunt (Sewell et al. [230]) to deliver cytotoxic agents.
In addition, instillation of sclerosing agents into the pleural space has been reported to have highly variable success rates of 20–88% (Sewell et al. [230]). Cytology may show the presence of tumour cells in effusion fluid, but even when these are absent, instillation of drugs may be effective in preventing recurrence due to the inflammatory reaction which obliterates the pleural space.
Agents used have included talc, radioactive phosphorus, bacille Calmette–Guérin (BCG), tetracycline and, more recently, cytotoxic drugs. The drug most frequently instilled is bleomycin, but others include mitoxantrone, doxorubicin, mustine and thiotepa (Sewell et al. [230], Wilkes [268]).
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