Pleurodesis or Indwelling Pleural Catheter for Management of Malignant Pleural Effusion: Evidence Based Case Report Alexander Randy Angianto 1 , Krishna Adi Wibisana 1 , Widayat Djoko Santoso 2 Departemen Ilmu Penyakit Dalam FKUI/RSCM Divisi Penyakit Tropik dan Infeksi, Departemen Ilmu Penyakit Dalam FKUI/RSCM ABSTRACT Pleural effusion is a condition when there is an accumulation of fluid in pleural space. The condition may manifest in breathing impairment by limiting lung expansion space. Pleural effusion is suffered by more than 1.5 million people per year in America. A study held in Persahabatan Hospital between 2010-2011 found 119 cases of pleural effusion, 42,8% was malignant pleural effusion. Pleural malignancy is the most common indication for thoracocentesis, thus must be considered in massive pleural effusion (MPE). Therapy for MPE is palliative with the goal being relief of dyspnea. Treatment options for MPE are detemined by several factors: symptoms and performance status of the patient, the primary tumor type and its response to systemic therapy, and degree of lung re-expansion following pleural fluid removal. In this case, we will present a case of malignant pleural effusion as an illustration in searching of evidence in comparing between pleurodesis and indwelling pleural catheter in management of malignant pleural effusion. Korespondensi: Alexander R Angianto Email: pulmonologi89@yahoo.co.id Indonesian Journal of CHEST Critical and Emergency Medicine Keywords: Pleural catheter, pleurodesis, malignant pleural effusion. Vol. 3, No. 1 Jan - Mar 2016 INTRODUCTION Pleural effusion is a condition when there is an accumulation of fluid in pleural space. The condition may manifest in breathing impairment by limiting lung expansion space. Pleural effusion is suffered by more than 1.5 million people per year in America. 1 A study held in Persahabatan Hospital between 2010- 2011 found 119 cases of pleural effusion, 42,8% was malignant pleural effusion. 2 Depends on the type of the fluid, generally pleural effusion can be classified into transudate and exudate pleural effusion. Most common etiologies of exudate pleural effusion by the incidence are pleural-related malignancies, parapleural infections, and lung embolism. 1 In parapleural infections cases, the volume of the effusion is usually small and rarery massive. Pleural malignancy is the most common indication for thoracocentesis, thus must be considered in massive pleural effusion. 1 The incidence of malignant pleural effusion (MPE) in population is around 200,000 people per year and it became a common cause of morbidity among cancer patients. 3 It has been associated with reduced life expectancy ranged from 3 months to 12 months depends on the type of primary malignancy, histological type, and stage. 4 In most series, lung cancer is the leading cause of malignant pleural effusion in men (50%) and it has been observed to have the shortest survival time, while breast cancer is the leading cause in women (40%). 4 At least 50% of patients with lung cancer develop pleural effusion regardless of the cell types, but most frequent with adenocarcinoma, while small cell types have a lower incidence. 1 Therapy for MPE is palliative with the goal is relief of dyspnea. 3 The initial step of managing patients with MPE is to identify the primary lesion of malignancy, so it can be decided whether systemic chemotherapy is indicated. 1 In conditions where the primary malignancy is not responsive to chemotherapy or where chemotherapy cannot improve clinical condition, the removal of pleural 21