Pleural Bleomycin vs Mechanical Abrasion in Malignant Pleural Effusion

Inclusion Criteria: * Patients who are 18 years old or more. * patients with rapidly accumulating moderate \& massive malignant pleural. effusion that need frequent aspiration to relieve dyspnea and affect quality of life of the patient. Exclusion Criteria: * patients not fit for thoracoscoy. * patients with life expectency less than 1 month . * trapped lung (endobronchial lesion). * excessive pleural adhesios. * mild effusion not need frequent aspiration and not affect * quality of life . * patients with chest infection : pneumonia , empyema . * patients with performance status that doesn't expected to increase by 1