***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 IMPORTANCE For treatment of malignant pleural effusion , nonsteroidal anti-inflammatory drugs ( NSAIDs ) are avoided because they may reduce pleurodesis efficacy . Smaller chest tubes may be less painful than larger tubes , but efficacy in pleurodesis has not been proven . OBJECTIVE To assess the effect of chest tube size and analgesia ( NSAIDs vs opiates ) on pain and clinical efficacy related to pleurodesis in patients with malignant pleural effusion . DESIGN , SETTING , AND PARTICIPANTS A 2 × 2 factorial phase 3 r and omized clinical trial among 320 patients requiring pleurodesis in 16 UK hospitals from 2007 to 2013 . INTERVENTIONS Patients undergoing thoracoscopy ( n = 206 ; clinical decision if biopsy was required ) received a 24F chest tube and were r and omized to receive opiates ( n = 103 ) vs NSAIDs ( n = 103 ) , and those not undergoing thoracoscopy ( n = 114 ) were r and omized to 1 of 4 groups ( 24F chest tube and opioids [ n = 28 ] ; 24F chest tube and NSAIDs [ n = 29 ] ; 12F chest tube and opioids [ n = 29 ] ; or 12F chest tube and NSAIDs [ n = 28 ] ) . MAIN OUTCOMES AND MEASURES Pain while chest tube was in place ( 0- to 100-mm visual analog scale [ VAS ] 4 times/d ; superiority comparison ) and pleurodesis efficacy at 3 months ( failure defined as need for further pleural intervention ; noninferiority comparison ; margin , 15 % ) . RESULTS Pain scores in the opiate group ( n = 150 ) vs the NSAID group ( n = 144 ) were not significantly different ( mean VAS score , 23.8 mm vs 22.1 mm ; adjusted difference , -1.5 mm ; 95 % CI , -5.0 to 2.0 mm ; P = .40 ) , but the NSAID group required more rescue analgesia ( 26.3 % vs 38.1 % ; rate ratio , 2.1 ; 95 % CI , 1.3 - 3.4 ; P = .003 ) . Pleurodesis failure occurred in 30 patients ( 20 % ) in the opiate group and 33 ( 23 % ) in the NSAID group , meeting criteria for noninferiority ( difference , -3 % ; 1-sided 95 % CI , -10 % to ∞ ; P = .004 for noninferiority ) . Pain scores were lower among patients in the 12F chest tube group ( n = 54 ) vs the 24F group ( n = 56 ) ( mean VAS score , 22.0 mm vs 26.8 mm ; adjusted difference , -6.0 mm ; 95 % CI , -11.7 to -0.2 mm ; P = .04 ) and 12F chest tubes vs 24F chest tubes were associated with higher pleurodesis failure ( 30 % vs 24 % ) , failing to meet noninferiority criteria ( difference , -6 % ; 1-sided 95 % CI , -20 % to ∞ ; P = .14 for noninferiority ) . Complications during chest tube insertion occurred more commonly with 12F tubes ( 14 % vs 24 % ; odds ratio , 1.91 ; P = .20 ) . CONCLUSIONS AND RELEVANCE Use of NSAIDs vs opiates result ed in no significant difference in pain scores but was associated with more rescue medication . NSAID use result ed in noninferior rates of pleurodesis efficacy at 3 months . Placement of 12F chest tubes vs 24F chest tubes was associated with a statistically significant but clinical ly modest reduction in pain but failed to meet noninferiority criteria for pleurodesis efficacy . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N33288337 BACKGROUND Symptomatic malignant pleural effusion ( MPE ) occurs frequently in patients with metastatic cancer . The associated prognosis is poor and the success rate of talc pleurodesis ( TP ) is low . Indwelling pleural catheters ( IPCs ) are commonly inserted when TP has been unsuccessful . METHODS We compared talc pleurodesis with the use of an indwelling pleural catheter in patients with recurrent MPE in a multicenter r and omized controlled trial ( superiority design ) . The primary endpoint was improvement from baseline in Modified Borg Score ( MBS ) 6weeks after r and omized treatment . Secondary endpoints were hospitalization days , re- interventions , and adverse events . RESULTS Dyspnea improved significantly ( p<0.01 ) after either treatment , but the magnitude of this improvement did not differ significantly between arms ( median 3 and 1 for TP : IPC respectively in rest , p=0.16 , ( TP 13:IPC 16 ) and 3 and 1 during exercise , p=0.72 ( TP 13:IPC 17 ) ) . There was no difference in dyspnea during exercise between TP and IPC at week 6 following treatment , while at rest TP patients ( n=13 ) reported less dyspnea than IPC patients ( n=18 ) ( median 0 vs 1 , p=0.002 ) . Compared to TP , patients with an IPC had significantly less hospital days during r and omized treatment ( median : 0 vs 5 , p<0.0001 ) , and total hospitalizations for all causes ( median : 1.6 vs 1.0 , p=0.0035 ) . Fewer IPC patients underwent more than one re-intervention ( 7/45 vs 15/43 , p=0.09 ) . The mean number of re- interventions was lower following IPC ( 0.21 vs 0.53 , p=0.05 ) . Equal number of adverse events occurred . CONCLUSIONS IPC was not superior in the primary endpoint , improvement of the modified Borg scale ( MBS ) . However , IPC patients had lower hospital stay , fewer admissions and fewer re- interventions . The IPC is an effective treatment modality in patients with symptomatic malignant pleural effusion The purpose of this study was to compare the effectiveness and safety of a chronic indwelling pleural catheter with doxycycline pleurodesis via tube thoracostomy in the treatment of patients with recurrent symptomatic malignant pleural effusions ( MPE ) STUDY OBJECTIVE To demonstrate the efficacy , safety , and appropriate mode of instillation of talc for sclerosis in treatment of malignant pleural effusions ( MPEs ) . DESIGN A prospect i ve , r and omized trial was design ed to compare thoracoscopy with talc insufflation ( TTI ) to thoracostomy and talc slurry ( TS ) for patients with documented MPE . MEASUREMENTS The primary end point was 30-day freedom from radiographic MPE recurrence among surviving patients whose lungs initially re-exp and ed > 90 % . Morbidity , mortality , and quality of life were also assessed . RESULTS Of 501 patients registered , those eligible were r and omized to TTI ( n = 242 ) or TS ( n = 240 ) . Patient demographics and primary malignancies were similar between study arms . Overall , there was no difference between study arms in the percentage of patients with successful 30-day outcomes ( TTI , 78 % ; TS , 71 % ) . However , the subgroup of patients with primary lung or breast cancer had higher success with TTI than with TS ( 82 % vs 67 % ) . Common morbidity included fever , dyspnea , and pain . Treatment-related mortality occurred in nine TTI patients and seven TS patients . Respiratory complications were more common following TTI than TS ( 14 % vs 6 % ) . Respiratory failure was observed in 4 % of TS patients and 8 % of TTI patients , accounting for five toxic deaths and six toxic deaths , respectively . Quality -of-life measurement demonstrated less fatigue with TTI than TS . Patient ratings of comfort and safety were also higher for TTI , but there were no differences on perceived value or convenience of the procedures . CONCLUSIONS Both methods of talc delivery are similar in efficacy ; TTI may be better for patients with either a lung or breast primary . The etiology and incidence of respiratory complications from talc need further exploration BACKGROUND Patients with malignant pleural effusion ( MPE ) have limited prognoses . They require long-lasting symptom relief with minimal hospitalization . Indwelling pleural catheters ( IPCs ) and talc pleurodesis are approved treatments for MPE . Establishing the implication s of IPC and talc pleurodesis on subsequent hospital stay will influence patient choice of treatment . Therefore , our objective was to compare patients with MPE treated with IPC vs pleurodesis  in terms of hospital bed days ( from procedure to death or end of follow-up ) and safety . METHODS In this prospect i ve , 12-month , multicenter study , patients with MPE were treated with IPC or talc pleurodesis , based on patient choice . Key end points were hospital bed days from procedure to death ( total and effusion-related ) . Complications , including infection and protein depletion , were monitored longitudinally . RESULTS One hundred sixty patients with MPE were recruited , and 65 required definitive fluid control ; 34 chose  IPCs  and 31 pleurodesis .  Total hospital bed days ( from any causes ) were significantly fewer in patients with IPCs ( median , 6.5 days ; interquartile range [ IQR ] = 3.75 - 13.0 vs pleurodesis , mean , 18.0 ; IQR , 8.0 - 26.0 ; P = .002 ) . Effusion-related hospital bed days were significantly fewer with IPCs ( median , 3.0 days ; IQR , 1.8 - 8.3 vs pleurodesis , median , 10.0 days ; IQR , 6.0 - 18.0 ; P < .001 ) . Patients with IPCs spent significantly fewer of their remaining days of life in hospital ( 8.0 % vs 11.2 % , P < .001 , χ(2 ) = 28.25 ) . Fewer patients with IPCs  required further pleural procedures ( 13.5 % vs 32.3 % in pleurodesis group ) . There was no difference in rates of pleural infection ( P = .68 ) and protein ( P = .65 ) or albumin loss ( P = .22 ) . More patients treated with IPC reported immediate ( within 7 days ) improvements in quality of life and dyspnea . CONCLUSIONS Patients treated with IPCs required significantly fewer days in hospital and fewer additional pleural procedures than those who received pleurodesis . Safety profiles and symptom control were comparable CONTEXT Malignant pleural effusion causes disabling dyspnea in patients with a short life expectancy . Palliation is achieved by fluid drainage , but the most effective first-line method has not been determined . OBJECTIVE To determine whether indwelling pleural catheters ( IPCs ) are more effective than chest tube and talc slurry pleurodesis ( talc ) at relieving dyspnea . DESIGN Unblinded r and omized controlled trial ( Second Therapeutic Intervention in Malignant Effusion Trial [ TIME2 ] ) comparing IPC and talc ( 1:1 ) for which 106 patients with malignant pleural effusion who had not previously undergone pleurodesis were recruited from 143 patients who were treated 
    Output:
    
No differences in survival or measures of dyspnea were observed in any of the studies .
No differences were noted in other adverse events .
Conclusions : Compared with chemical pleurodesis , IPC results in shorter hospital length of stay and fewer repeat pleural procedures but carries a higher risk of cellulitis .