Malignant ascites (MA) - fluid within abdominal cavity due to intraperitoneal (IP) invasion by cancer cells - is a sign of advanced cancer and causes distressful symptoms such as abdominal pain and dyspnea. Aim: To determine the safety and effectiveness of interventions for MA in adults with advanced cancer. We searched 5 electronic databases (April 2015), conducted citation searching and checked reference lists of included articles and 3 systematic reviews. We included randomised controlled trials and controlled clinical trials (RCTs / CCTs). 1 author screened titles/abstracts. Further screening, data extraction and quality assessment were independently conducted by 2 authors and a 3rd in cases of disagreement. We identified 5 studies (4 RCTs, 1 CCT), with 648 participants. When reported, age ranged between 23-92 years, 77% were women and most common primary cancers were ovarian (OC) (50%) and gastrointestinal (23%). 4 interventions were pharmacological: IP Cisplatin plus Bevacizumab did not cause adverse effects (AE) and enhanced quality of life (QoL) in MA of OC, compared to IP Cisplatin alone (1 RCT, n = 58); IP Catumaxomab when added to paracentesis induced more AE (abdominal pain, pyrexia, vomiting/nausea), despite reduction in MA-related symptoms (1 RCT, n = 258); IP Catumaxomab-induced AE failed to be prevented by Intravenous Prednisolone (1 RCT, n = 219); Intramuscular Long-acting (LA)-Octreotide did not increase AE, but had limited QoL benefit compared to placebo (1 RCT, n = 33). 1 non-pharmacological intervention, abdominal massage, was safe and reduced abdominal bloating, depression and anxiety, compared to social interaction (1 CCT, n = 58). Cisplatin plus Bevacizumab appears safe and effective for the management of MA in OC, Catumaxomab added to parencentesis increased AE, LA-Octreotide appears safe but with limited effectiveness, and abdominal massage is promising. However, these findings need to be confirmed in more trials.