The intrapleural instillation of agents for pleural
sclerosis has proved effective in preventing the reaccumulation of symptomatic
malignant pleural effusions. Because manufacture of the most popular agent,
tetracycline, was recently discontinued, a preliminary study was undertaken to evaluate an alternative agent,
doxycycline, for treating symptomatic
malignant pleural effusions. From November 1991 to September 1992, 21 patients with symptomatic
malignant pleural effusions have undergone overnight
chest tube drainage followed by intrapleural instillation of 10 mL 1%
lidocaine and then
doxycycline, 500 mg in 30 mL
0.9% saline solution. The
chest tube was clamped 2 hours with patient repositioning every 15 minutes. Tubes were removed when drainage was less than 50 mL/8 h. Of surviving patients, a complete objective response at 1 month was obtained in 88% (15/17), who were free of a symptomatic or radiographic recurrence of the effusion. Complications included mild
pain in 23% (5/21), moderate
pain requiring
analgesics in 19% (4/21), and mild
fever in 5% (1/21). There were no treatment-related deaths. The mean time for
chest tube removal was 1.7 +/- 0.7 days after the last treatment. Based on this preliminary study, we conclude that
doxycycline is a highly effective agent for the
palliative treatment of symptomatic
malignant pleural effusions. Its safety profile and efficacy compare favorably with those of
tetracycline and other agents used for pleural
sclerosis.