Outcome of Tetracycline Pleurodesis in Patients with Malignant Pleural Effusion

Abstract

Background: Malignant pleural effusion (MPE) is a frequent complication of advanced cancers, significantly impairing respiratory function and quality of life. Chemical pleurodesis is a cornerstone of palliative management, particularly in recurrent effusions. While talc remains the preferred agent globally, tetracycline continues to be widely used in low-resource settings due to its affordability and accessibility, though contemporary evidence regarding its efficacy and safety remains limited. Objective: To determine the short-term clinical outcome of tetracycline pleurodesis in patients with cytologically confirmed malignant pleural effusion. Methods: This single-center descriptive observational study was conducted at the Department of Pulmonology, Lady Reading Hospital, Peshawar, from November 2024 to April 2025. A total of 89 adult patients with confirmed MPE underwent chemical pleurodesis via chest tube using tetracycline powder (35 mg/kg) suspended in lidocaine-saline solution. Pleurodesis success was defined as no radiographic effusion recurrence at 30 days. Secondary outcomes included post-procedure chest pain and fever. Stratified analyses assessed associations with demographic and clinical variables. Results: Pleurodesis was successful in 67 of 89 patients (75.3%). Chest pain and fever occurred in 22.5% and 20.2% of patients, respectively; all events were self-limiting. No statistically significant predictors of success were identified. No serious complications or mortality occurred. Conclusion: Tetracycline pleurodesis is a safe and moderately effective option for short-term control of malignant pleural effusion, offering a viable palliative strategy where access to talc is limited.