How to Manage a New Malignant Pleurolufusion on Their First Presentation

The patient underwent a right thoracentesis and the effusion with serousangrenous appearance. cytology came back positive for malignant cells consistent with an adenocarcinoma. After this initial thurscentesis, the patient felt better but he still remained on one to two liters of oxygen. No pneumothorax was confirmed. He did have some re-expansion of the lung but there still appeared to be a moderate effusion. And David, I'm wondering if you could tell us your approach to management of a patient such as this with a new malignant pleurolufusion on their first presentation.