***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Treatment of patients with malignant pleural effusions is mostly palliative .  Tetracycline and bleomycin  are the two most commonly used agents for the treatment of pleurodesis . In this study , the authors used a combination of the two drugs for this particular purpose Summary The current prospect i ve r and omized study was design ed to compare the effects of intracavitary ( i.c . ) chemotherapy vs immunotherapy vs immunochemotherapy for malignant effusion . Between 1992 and 1995 , a total of 42 patients with malignant effusion were registered , and 41 patients were eligible for statistical analysis . The primary diseases of the eligible patients included 27 gastric , four colorectal , four pancreatic , three lung , two liver and one oesophageal cancers . The patients with malignant effusion were r and omly assigned into one of three i.c . therapeutic regimens : chemotherapy alone with weekly injection of anticancer agents ( ACAs : cisplatin , mitomycin-C , adriamycin , etc . ) ( Group A , n = 13 ) ; immunotherapy alone with weekly injection of streptococcal preparation OK-432 ( Group B , n = 14 ) ; or immunochemotherapy with ACAs and OK-432 ( Group C , n = 14 ) . The response of the effusion , patient survival and the kinetics of cytokines in the effusion were compared . There were no differences in the patients ’ background s. The side-effects of the regimens included pain , anorexia , fever , leucopenia and anaemia and there were no differences in their incidence among the three groups . One patient died after cisplatin ( CDDP ) administration in Group A. Cytologic examination revealed that tumour cells in the effusion disappeared in 23 % of Group A cases , 36 % of Group B cases and 36 % of Group C cases . The malignant effusion did not disappear in any of the Group A cases ; however , the effusion disappeared in 29 % of Group B cases and 43 % of Group C cases ( P = 0.03 , Group A vs Group C ) . Furthermore , the 50 % survival period was 1.6 months for Group A , 2.4 months for Group B and 3.5 months for Group C. The 6-month survival rate was 7 % for Group A , 6 % for Group B and 34 % for Group C , and the 1-year survival rate was 0 % , 0 % and 17 % respectively ( P = 0.048 , Group A vs Group C by the log-rank test ) . The analysis of the cytokine kinetics revealed a prominent increase in the level of interleukin-6 in the effusion in Group C. These results suggest that i.c . immunochemotherapy with OK-432 and ACAs may be more beneficial than i.c . chemotherapy alone or immunotherapy alone The optimal strategy to achieve palliation of  malignant pleural effusions ( MPEs )  is unknown . This multi-institutional , prospect i ve , r and omized trial compares 2 established methods for controlling symptomatic unilateral MPEs . Patients with unilateral MPEs were r and omized to either daily tunneled catheter drainage ( TCD ) or bedside talc pleurodesis ( TP ) . This trial is patterned after a previous r and omized trial that showed that bedside TP was equivalent to thoracoscopic TP ( CALGB 9334 ) . The primary end point of the current study was combined success : consistent/reliable drainage/pleurodesis , lung expansion , and 30-day survival . A secondary end point , survival with effusion control , was added retrospectively . This trial r and omized 57 patients who were similar in terms of age ( 62 years ) , active chemotherapy ( 28 % ) , and histologic diagnosis ( lung , 63 % ; breast , 12 % ; other/unknown cancers , 25 % ) to either bedside TP or TCD .  Combined success was higher with TCD ( 62 % ) than with TP ( 46 % ; odds ratio , 5.0 ; P = .064 ) . Multivariate regression analysis revealed that patients treated with TCD had better 30-day activity without dyspnea scores ( 8.7 vs. 5.9 ; P = .036 ) , especially in the subgroup with impaired expansion ( 9.1 vs. 4.6 ; P = .042 ) . Patients who underwent TCD had better survival with effusion control at 30 days compared with those who underwent TP ( 82 % vs. 52 % , respectively ; P = .024 ) . In this prospect i ve r and omized trial , TCD achieved superior palliation of unilateral MPEs than TP , particularly in patients with trapped lungs Background : Iodopovidone is an alternative agent used to promote pleurodesis in patients with malignant pleural effusion ( MPE ) . However , safety is a concern , and many authors still reject its use . Objectives : Our main objective is to describe the occurrence of common and severe adverse events after pleurodesis with two different doses of iodopovidone in patients with MPE . Our secondary objective is to evaluate dose dependency , efficacy , quality of life , and systemic inflammation . Methods : We conducted a double-blind , r and omized clinical trial including patients with recurrent MPE . Patients underwent chest tube insertion  and were r and omized into two groups according to the doses of iodopovidone : group 1 received 1 % iodopovidone , and group 2 received 2 % iodopovidone . During follow-up , adverse events , inflammatory markers , quality of life , and imaging exams were systematic ally evaluated and registered . Results : Sixty patients were analyzed ( 55 females , 5 males , median age 55.9 years ) . Overall , 227 adverse events possibly related to pleurodesis were registered , including 47 serious adverse events ( in 34 patients ) . Pleuritic pain and hypertensive peaks were the most frequently observed serious adverse events ( 11 and 10 episodes , respectively ) . Grade 3/4 metabolic events such as hyponatremia and an increase in alkaline phosphatase , AST and ALT levels were also common . C-reactive protein ( CRP ) levels increased substantially and peaked 48 h after pleurodesis . No difference was observed between groups with regard to adverse events , CRP levels , efficacy , or quality of life . Conclusions : Adverse events after iodopovidone pleurodesis in patients with MPE are common and similar in the two doses studied BACKGROUND Malignant pleural mesothelioma incidence continues to rise , with few available evidence -based therapeutic options . Results of previous non-r and omised studies suggested that video-assisted thoracoscopic partial pleurectomy ( VAT-PP ) might improve symptom control and survival . We aim ed to compare efficacy in terms of overall survival , and cost , of VAT-PP and talc pleurodesis in patients with malignant pleural mesothelioma . METHODS We undertook an open-label , parallel-group , r and omised , controlled trial in patients aged 18 years or older with any subtype of confirmed or suspected mesothelioma with pleural effusion , recruited from 12 hospitals in the UK . Eligible patients were r and omly assigned ( 1:1 ) to either VAT-PP or talc pleurodesis by computer-generated r and om numbers , stratified by European Organisation for Research and Treatment of Cancer risk category ( high vs low ) . The primary outcome was overall survival at 1 year , analysed by intention to treat ( all patients r and omly assigned to a treatment group with a final diagnosis of mesothelioma ) . This trial is registered with Clinical Trials.gov , number NCT00821860 . FINDINGS Between Oct 24 , 2003 , and Jan 24 , 2012 , we r and omly assigned 196 patients , of whom 175 ( 88 assigned to talc pleurodesis , 87 assigned to VAT-PP ) had confirmed mesothelioma . Overall survival at 1 year was 52 % ( 95 % CI 41 - 62 ) in the VAT-PP group and 57 % ( 46 - 66 ) in the talc pleurodesis group ( hazard ratio 1·04 [ 95 % CI 0·76 - 1·42 ] ; p=0·81 ) . Surgical complications were significantly more common after VAT-PP than after talc pleurodesis , occurring in 24 ( 31 % ) of 78 patients who completed VAT-PP versus ten ( 14 % ) of 73 patients who completed talc pleurodesis ( p=0·019 ) , as were respiratory complications ( 19 [ 24 % ] vs 11 [ 15 % ] ; p=0·22 ) and air-leak beyond 10 days ( five [ 6 % ] vs one [ 1 % ] ; p=0·21 ) , although not significantly so . Median hospital stay was longer at 7 days ( IQR 5 - 11 ) in patients who received VAT-PP compared with 3 days ( 2 - 5 ) for those who received talc pleurodesis ( p<0·0001 ) . INTERPRETATION VAT-PP is not recommended to improve overall survival in patients with pleural effusion due to malignant pleural mesothelioma , and talc pleurodesis might be preferable considering the fewer complications and shorter hospital stay associated with this treatment . FUNDING BUPA Foundation In a controlled r and omized trial , 46 patients with pleural effusions secondary to breast cancer were treated at first diagnosis with either intracavitary mustine or talc , to determine which agent produced the more effective pleurodesis . Of the 37 evaluable patients , control of the effusion was achieved in 9/17 ( 56 % ) of those treated with mustine and 18/20 ( 90 % ) of the talc group ( P > 0.025 ) . This suggests that early treatment with intracavitary talc can effectively palliate this complication of breast cancer Thirty two patients with malignant pleural effusion were r and omly allocated to treatment with intrapleural Corynebacterium parvum or tetracycline hydrochloride in an attempt to prevent symptomatic recurrence of pleural fluid . Success in preventing recurrence of fluid at one month , using up to 2 doses of each drug , was 14 of 16 cases for Corynebacterium parvum , 5 of 9 for tetracycline given via an intercostal needle , and 6 of 7 for tetracycline given through an intercostal tube . These difference were not statistically significant . Corynebacterium parvum was significantly more likely to produce pyrexia equal or greater than 38 degrees C ( P less than 0.001 ) and pain requiring analgesia ( P less than 0.05 ) than tetracycline hydrochloride . Corynebacterium parvum is a useful agent for the management of malignant pleural effusion , but is associated with more side effects than tetracycline Introduction Malignant pleural effusion can complicate most cancers . It causes breathlessness and requires hospitalisation for invasive pleural drainages . Malignant effusions often herald advanced cancers and limited prognosis . Minimising time spent in hospital is of high priority to patients and their families . Various treatment strategies exist for the management of malignant effusions , though there is no consensus governing the best choice . Talc pleurodesis is the conventional management but requires hospitalisation ( and substantial healthcare re sources ) , can cause significant side effects , and has a suboptimal success rate . Indwelling pleural catheters ( IPCs ) allow ambulatory fluid drainage without hospitalisation , and are increasingly employed for management of malignant effusions . Previous studies have only investigated the length of hospital care immediately related to IPC insertion . Whether IPC management reduces time spent in hospital in the patients ’ remaining lifespan is unknown . A strategy of malignant effusion management that reduces hospital admission days will allow patients to spend more time outside hospital , reduce costs and save healthcare re sources . Methods and analysis The Australasian Malignant Pleural Effusion ( AMPLE ) trial is a multicentred , r and omised trial design ed to compare IPC with talc pleurodesis for the management of malignant pleural effusion . This study will r and omise 146 adults with malignant pleural effusions ( 1:1 ) to IPC management or talc slurry pleurodesis .  The primary end point is the total number of days spent in hospital ( for any admissions ) from treatment procedure to death or end of study follow-up . Secondary end points include hospital days specific to pleural effusion management , adverse events , self-reported symptom and quality -of-life scores . Ethics and dissemination The Sir Charles Gairdner Group Human Research Ethics Committee has approved the study as have the ethics boards of all the participating hospitals . The trial results will be published in peer- review ed journals and presented at scientific conferences . Trial registration numbers Australia New Zeal and Clinical Trials Registry — ACTRN12611000567921 ; National Institutes of Health — NCT02045121 PURPOSE To compare bleomycin pleurodesis and immunotherapy with intrapleural interferon alfa-2b ( IFN ) in the palliation of malignant pleural effusions . PATIENTS AND METHODS One hundred sixty patients with rapidly recurrent malignant pleural effusion were r and omly assigned to intrapleural bleomycin ( 83 patients ) or IFN ( 77 patients ) . A 9-French intrapleural catheter was placed under sonographic guidance , and pleural effusion 
    Output:
    
No differences between interventions were revealed by the network meta- analysis of the pain data .
Based on the available evidence , talc poudrage is a more effective pleurodesis method in MPE than a number of other frequently used methods , including tetracycline and bleomycin .
Based on the strength of the evidence from both direct and indirect comparisons of r and omised data of sclerosants administered at the bedside , there is no evidence to suggest large differences between the other highly effective methods ( talc slurry , mepacrine , iodine and C. parvum ) .