***TASK*** the task is to summarize 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 STUDY OBJECTIVE To determine the feasibility of rapid pleurodesis in patients with malignant pleural effusions in order to reduce hospital length of stay in patients with a limited life expectancy . DESIGN Prospect i ve case series . SETTING Two university hospital programs . PATIENTS Thirty-eight patients with symptomatic pleural effusions associated with malignancy . INTERVENTIONS A 14F catheter was inserted percutaneously into the pleural space after radiographic confirmation of free fluid by lateral decubitus views . Following radiographic confirmation of complete fluid evacuation , a sclerosing agent ( ie , talc slurry or bleomycin ) was instilled into the pleural space . This was accomplished within 2 h of chest tube insertion , unless the tube was inserted in the evening or if the lung was trapped . After clamping the tube for 90 min , the pleural space was drained for 2 h , after which the chest tube was removed . The intervention was scored as " successful " if no radiographic evidence of fluid reaccumulation was noted at 4 weeks . A " partial successful " score indicated reaccumulation of fluid that did not produce symptoms and did not require repeat pleural drainage of any sort . All other outcomes were scored as " unsuccessful . " MEASUREMENTS AND RESULTS Forty chest tubes were inserted into 38 patients . Four procedures revealed the presence of a trapped lung and did not result in any attempt at pleurodesis . Five patients who received pleurodesis  died in less than 1 month and therefore were not evaluable . Two patients had technical problems with the chest tube and were not evaluable . Of the remaining 29 procedures , drainage procedures with pleurodesis were performed in 27 patients , a complete response was seen in 14 patients ( 48 % ) , a partial response was seen in 9 patients ( 31 % ) , and 6 patients ( 21 % ) did not respond to pleurodesis . Chemical pleurodesis was completed as an outpatient procedure in only two patients . In one of these , the outcome was unsuccessful . In the remainder , insertion of the chest tube in the evening or additional medical problems necessitated hospital admission , but the entire procedure was completed within 24 h. CONCLUSIONS Chemical pleurodesis can be accomplished with good results in < 24 h in the majority of patients with malignant pleural effusions 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 Malignant pleural effusions are commonly managed with tube thoracostomy drainage followed by chemical pleurodesis . Both tetracycline and bleomycin have been shown to be effective for intrapleural instillation , although neither agent has definitively proved advantages over the other . The aim of the present study was to compare these two agents in terms of response rate and toxicity profile . A prospect i ve , r and omized trial was carried out in a single centre . Between May 1993 and January 1996 , 62 evaluable patients with proved malignant pleural effusion were allocated to receive either intrapleural tetracycline ( 1.5 g ) or bleomycin ( 60 mg ) after the same drainage procedure . Demographic , clinical and fluid parameter data were comparable in both groups . Response was evaluated at 1 , 3 and 6 months after pleurodesis . Mean survival and time to relapse did not differ between the two groups . No statistically significant differences were found in terms of efficacy at each evaluation time . Overall , 16 ( 52 % ) and 20 ( 64 % ) patients had a recurrence of pleural effusion during follow-up in the tetracycline and bleomycin arms , respectively . Fever was most common in bleomycin-treated patients ( p=0.024 ) while pain was most frequent in the tetracycline arm ( nonsignificant ) . Since no study agent was superior to the other in this trial , we suggest that economic costs , drug availability and medical skill should be considered in the choice of a sclerosing agent Fifty-eight patients with malignant pleural effusions were entered into a prospect ively r and omized clinical trial comparing the efficacy of a local instillation of bleomycin or corynebacterium parvum ( C. parvum ) in controlling fluid reaccumulation after simple needle aspiration ( thoracentesis ) . The response was assessed at 30 days by chest X-ray and clinical examination . There were 44 evaluable patients ; 18 of 25 ( 72 % ) of those receiving bleomycin and 9/19 ( 47 % ) of those who had C. parvum gained a complete or partial response . This difference in response rate was not statistically significant ( p = 0.13 ) . The majority of patients had an effusion from a primary breast carcinoma and the response in this group was almost statistically significant ( p = 0.06 ) with 74 % of bleomycin patients and 43 % of C. parvum patients responding . Fever following instillation was more common with C. parvum ( 53 % of patients compared with 24 % after bleomycin , p = 0.02 ) , whereas nausea was more common after bleomycin ( 28 % vs. 10.5 % , p = 0.16 ) . Local chest pain after aspiration occurred in 52 % of the bleomycin group and 47 % of the C. parvum subjects . There was no significant difference between the groups in age , sex , tumour type , presenting symptoms , volume of aspirate , systemic therapy or number of previous aspirations . Both of these agents appeared to be active in the control of malignant pleural effusions although the response rate was higher with bleomycin and overall , both have acceptable levels of toxicity BACKGROUND --A study was undertaken to compare the efficacy of short term tube thoracostomy drainage with st and ard tube thoracostomy drainage before instillation of tetracycline for sclerotherapy of malignant pleural effusions . METHODS --The study consisted of a r and omised clinical trial in a sequential sample of 25 patients with malignant pleural effusions documented cytopathologically . Fifteen patients were r and omly assigned to group 1 ( st and ard protocol ) and 10 to group 2 ( short term protocol ) . Patients in group 1 had tube thoracostomy suction drainage until radiological evidence of lung re-expansion was obtained and the amount of fluid drained was < 150 ml/day , before tetracycline ( 1.5 g ) was instilled . The chest tube was removed when the amount of fluid drained after instillation was < 150 ml/day . Patients in group 2 also had suction drainage , but the tetracycline ( 1.5 g ) was instilled when the chest radiograph showed the lung to be re-exp and ed and the effusion drained , which was usually within 24 hours . The chest tube was removed the next day . RESULTS --The response to tetracycline sclerotherapy  in the two groups was the same ( 80 % ) but the duration of chest tube drainage was significantly shorter for patients in group 2 ( median two days ) than for those in group 1 ( median seven days ) . CONCLUSIONS --The duration of chest tube drainage before sclerotherapy for malignant pleural effusions need not be influenced by the amount of fluid drained daily but by radiographic evidence of fluid evacuation and lung re-expansion . Shorter duration of drainage will reduce the length of hospital stay without sacrificing the efficacy of pleurodesis BACKGROUND Talc has been generally accepted to be the most effective sclerosant for chemical pleurodesis , although the optimal route of administration remains unclear . METHODS We design ed a prospect i ve , r and omized study to compare video-assisted thoracoscopic talc insufflation with bedside talc slurry in the treatment of malignant pleural effusion . From September 1993 to November 1995 , 57 patients were recruited and r and omized to either video-assisted thoracoscopic talc insufflation under general anesthesia ( n = 28 ) or talc slurry by the bedside ( n = 29 ) . Patients with poor general condition ( Karnofsky score less than 30 % ) , poor pulmonary function ( forced expiratory volume in 1 second less than 0.5 L ) , or trapped lungs were excluded from this study . Five grams of purified talc was used for either video-assisted thoracoscopic talc insufflation or talc slurry . RESULTS There was no statistically significant difference between the two groups of patients with respect to age , sex ratio , chest drainage duration , postprocedural hospital stay , parenteral narcotics requirement , complications , or procedure failure ( ie , recurrence ) . CONCLUSIONS Video-assisted thoracoscopic talc insufflation has not been shown to be a superior approach compared with talc slurry in our study . Because the former dem and s more re sources , we advocate that talc slurry should be considered as the procedure of choice in the treatment of symptomatic malignant pleural effusion in patients who do not have trapped lungs The efficacy and safety of intrapleural LC9018 ( Yakult Co. Ltd. , Tokyo , Japan ) with or without doxorubicin ( Adriamycin ; Adria Laboratories , Columbus , OH ) were evaluated in a r and omized , controlled trial performed in 95 patients with malignant pleural effusions secondary to lung cancer . Seventy‐six patients were eligible for the assessment of efficacy . The response 
    Output:
    
The use of sclerosants ( mitozantrone , talc and tetracycline combined)compared with control ( instillation of isotonic saline or equivalent pH isotonic saline or tube drainage alone ) was associated with an increased efficacy of pleurodesis .
REVIEW ER 'S CONCLUSIONS The available evidence supports the need for chemical sclerosants for successful pleurodesis , the use of talc as the sclerosant of choice , and thoracoscopic pleurodesis as the preferred technique for pleurodesis based on efficacy .
There was no evidence for an increase in mortality following talc pleurodesis