Palliative Treatment of Malignant Pleural Effusions: Valueof Small-Bore CatheterThoracostomyand Doxycycline Sclerotherapy

OBJECTIVE. This study evaluates small-bore catheter thoracostomy combined with doxycycline sclerotherapy for palliative treatment of presumed malignant pleural eff u- sions. SUBJECTS AND METHODS. Forty-seven consecutive patients referred from the medi- cal oncology department to the thoracic radiology section with known primary malignant tumors and symptomatic pleural effusions over a 2-year period were treated with small- bore pleural catheter drainage followed by doxycycline scierotherapy. Of the 47 patients, 20 (43%) died less than 30 days after sclerotherapy, one (2%) died without radiographic follow-up, and five (11%) were lost to follow-up. Twenty-one patients formed the study group. Response to treatment was defIned based on fIndings on follow-up chest radio- graphs obtained 30 days after sclerotherapy as complete (no reaccumulation of pleural effusion), partial (accumulation above postpleurodesls level but below that at presents- tion), or as a failure (reaccumulation to the amount seen at presentation). RESULTS. Seventeen (81%) evaluable patients showed complete response to sclero- therapy, three (14%) showed a partial response, and one (5%) showed no response. All complete and partial responders were clinically improved with resolution of their short- ness of breath. Therefore, 95% of evaluable patients had clinically and radiographically successful treatment. Six patients underwent sclerotherapy when their tube output was greater than 100 m1124hr. Five of the six had completely successful pleurodesis, and one failed to respond. TWo(10%) of the 21 patients had greater than 150 ml drainage In the 24 hr after Initial doxycycline administration and were therefore given a second dose of intrapleural doxycycline. Both of these patients subsequently had less than 150 ml drain- age in an additional 24-hr observation period and went on to complete response. Compli- cations included three patients (14%) with mild discomfort at the chest tube site during drainage, one patient (5%) with pain during instillation of doxycycline, and one patient (5%) with transient fever (38.3#{176}C body temperature) one day after scierotherapy. CONCLUSION. Small-bore catheter thoracostomy followed by doxycycline sclero- therapy successfully resolves symptomatic pleural effusion in patients with known