In conclusion, the best treatment of a malignant pleural effusion is not known. The treatment should be based on the clinical situation and patient preferences, as well as local expertise. Prospective randomized controlled studies are needed to identify the optimal treatment, taking into consideration the quality of life, success rates, complications, and cost. Until such studies are available, I believe that the best treatment of most patients is the implantation of an indwelling pleural catheter. I gave a talk at M.D. Anderson in 2010 on the treatment of malignant pleural effusions, discussing both the indwelling catheter and pleurodesis. I was surprised when one of the physicians in the audience asked me why I even discussed pleurodesis; virtually all malignant pleural effusions at that institution are treated with the indwelling catheter.