Use of Capsule Tetracycline for Pleurodesis in Breast Cancer Patients with Malignant Pleural Effusion

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Background: Pleurodesis is an effective treatment for malignant pleural effusion but the ideal agent that will combine efficacy with safety and ease of administration remains under debate. Injectable tetracycline used to be the preferred agent for sclerosis for many clinicians but it has been withdrawn from the market. There is thus an ongoing search for suitable and better alternatives. In a third world environment, cost is a major determinant of use of some agents. Some patients have already been heavily pretreated with systemic cytotoxic drugs while some are too weak for agents with cytotoxic activity. All these limit the choice of agents available to us. Patients and Methods: Capsules of tetracycline were dissolved in sterile water and this was injected through a thoracostomy tube in patients with malignant pleural effusion from breast cancer. The efficacy was measured by its ability to the control effusion for at least 30 days as evidenced by non recurrence of clinical features of effusion necessitating re-treatment and/or chest radiology showing more than 50% fluid re-accumulation. Results: Twelve pleural effusions were treated with capsule tetracycline pleurodesis. Eleven effusions satisfied evaluation criteria. Eight of eleven evaluable pleural effusions (72.7%) were controlled for at least 30 days or until patient's death or loss to follow up. The reactions following the use of the agent were minimal comprising only of mild to moderate chest pain, an episode of fever, body aches and vomiting. All the symptoms were controlled by simple measure like analgesics. Conclusion: Capsule tetracycline has shown good promise as a sclerosing agent for pleurodesis. A prospective randomized trial comparing it with other known agents is warranted. Key Words: Malignant pleural effusion, pleurodesis, capsule tetracycline. Journal of College of Medicine 2005: 9(2): 82-84