after joining the study, you will undergo a series of initial examinations that include medical history review, physical examination, laboratory tests, and imaging studies to document the extent of malignant pleural effusion.

the results of these assessments are used to confirm eligibility and to provide reference values for later comparisons.

based on the study design, you will be assigned by chance to one of two groups: the treatment group that receives hyperthermic intrathoracic chemotherapy (hithoc) with or without pleurectomy, or the control group that receives either chemical pleurodesis or an indwelling pleural catheter.

the assignment is concealed from you and the clinical team until the procedure day.

if you are allocated to the treatment group, you will be taken to the operating room for a thoracic surgery.

when pleurectomy is indicated, the surgeon will remove the affected pleural lining to reduce tumor burden.

following pleurectomy, or directly if pleurectomy is not performed, the chest cavity will be filled with a heated solution containing cisplatin.

the cisplatin dose is calculated as 150 mg per square meter of body‑surface area and is administered intrapleurally as a solution for infusion.

the heated solution is circulated within the chest for approximately sixty minutes, after which it is drained and the chest is closed.

if you are allocated to the control group, a standard procedure will be performed to manage the pleural effusion.

for chemical pleurodesis, a sclerosing agent is introduced into the pleural space to cause the lining to stick together and prevent fluid re‑accumulation.

alternatively, an indwelling pleural catheter may be placed, allowing you to drain fluid at home as needed.

after the procedure, you will stay in the hospital for observation.

vital signs, chest imaging, and laboratory tests will be checked regularly to detect any complications such as infection, bleeding, or respiratory problems.

pain management and respiratory therapy will be provided as required.

once discharged, you will attend scheduled follow‑up visits at regular intervals, typically every three months.

each visit includes physical examination, imaging studies, and questionnaires to evaluate quality of life.

the primary outcome measured during follow‑up is progression‑free survival, which tracks the time until the disease worsens.

additional assessments include overall survival and any further treatments that may be required.