Therapy of malignant pleural effusion tetracycline vs tetracycline/lidocaine

Pleural effusion is a common complication of malignant disease. Whether it is due to involvement of the pleura with tumor deposits leading to increased exudation of fluid or decreased absorption secondary to the blockade of subpleural lymphatics and venules, malignant pleural effusions are currently treated by methods designed to cause a sterile adhesive serositis resulting in obliteration of the pleural space. The efficacy of various modalities, from talc poudrage to antineoplastic agents, remains in question and appears to depend as much upon the expertise of the investigator as it does upon the particular agent chosen. It is clear, however, that various modalities have inherent toxicities that render them less than ideal for general application. Tetracycline is reported to be 83 percent - 100 percent effective in controlling malignant pleuraL effusions in two studies where it was used for sclerosis. It has been suggested that the combination of tetracycline and lidocaine may be used to decrease or eliminate the4 pain associated with intrapleural instillation of tetracycline. This study was designed to access the effect of lidocaine on the efficacy of tetracycline as a sclerosing agent.