Background: Malignant pleural effusion, which is a common clinical problem in patients
with cancer, may be due to both primary thoracic tumours or to a metastatic spread in the chest and
constitutes the first sign of disease in approximately 10% of patients. Almost all cancers can potentially
produce a pleural effusion. The presence of malignant tumour cells in the pleural fluid is
generally indicative of advanced disease and is associated with high morbidity and mortality with reduced
therapeutic options. Dyspnoea during mild physical activity or at rest is generally the typical
sign of restrictive respiratory failure.
Methods: This is a systematic review of all the main articles in the English language on the topic of
malignant pleural effusion and reported by the Pubmed database from 1959 to 2018. I reviewed the
literature and guidelines with the aims to focus on what is known and on future pathways to follow
the diagnosis and treatment of malignant pleural effusions.
Results: The main goal of palliation of a malignant pleural effusion is a quick improvement in
dyspnoea, while thoracentesis under ultrasound guidance is the treatment of choice for patients with a
limited life expectancy or who are not candidates for more invasive procedures such as drainage using
an indwelling small pleural catheter, chemical pleurodesis with sclerosing agents, pleurectomy or
Conclusion: Despite progress in therapeutic options, the prognosis remains severe, and the average
survival is 4-9 months from the diagnosis of malignant pleural effusion. Moreover, mortality is
higher for patients with malignant pleural effusion compared with those with metastatic cancer but
no malignant pleural effusion. Therefore, the prognosis of these patients primarily depends on the
underlying disease and the extension of a primary tumour. This review focuses on the most relevant
updates in the management of malignant pleural effusion.