TETRACYCLINE PLEURODESIS FOR TREATMENT OF MALIGNANT PLEURAL EFFUSIONS- A RETROSPECTIVE STUDY OF 91 CASES

BACKGROUND: Malignant pleural effusions (MPE) are a common complicatio n in patients with advanced neoplasms. Even though no large series con firming this exist, tetracycline pleurodesis has become the therapy of choice. The aim of this retrospective study was to evaluate its effic acy, adverse effects and possible factors predicting the success of th e methode. METHODS: Between 1985 through 1991, 91 patients with cytolo gically or histologically confirmed MPE were treated with 1,000-1,500 mg tetracycline pleurodesis. There were 49 females and 42 males, with a mean age of 59 years. The most common malignancies were lung, breast and unknown primary carcinomas. 85 % patients complained of dyspnea a nd the volume of the effusion was moderate in half the cases. 12 varia bles were analyzed in relation with the probability of response throug h chi2 test; survival and recurrence times were calculated with Kaplan and Meier's method. RESULTS: 73 patients were evaluable, with a 67 % response rate (22 complete, 27 partial). Time to relapse was significa ntly higher for partial responses (mean 112 days) than for failures (m ean 33 days). 37 patients presented mild complications (pain and fever ). Karnofsky performance status (70 % or greater), size of the effusio n (small or moderate), chest radiograph (only effusion) and pleural LD H (600 U/l or less) attained favourable prognostic significance. Media n survival was reached at 6 months. CONCLUSIONS: Tetracycline pleurode sis is an effective and well-tolerated paliative treatment for MPE. Al ong with other known parameters (pleural pH and glucose levels), Karno fsky performance status, size of the effusion, chest radiograph and pl eural LDH allow to predict its results and optimize its indications.