Local iodine pleurodesis versus thoracoscopic talc insufflation in recurrent malignant pleural effusion: a prospective randomized control trial

Mohsen, Tarek A.; Zeid, Amany A. Abou; Meshref, Mohamed; Tawfeek, Nehad; Redmond, Karen; Ananiadou, Olga G.; Haj-Yahia, Saleem
August 2011
European Journal of Cardio-Thoracic Surgery;Aug2011, Vol. 40 Issue 2, p282
Academic Journal
Abstract: Objective: To compare the efficacy, safety, and outcome of thoracoscopic talc poudrage (TTP) versus povidone–iodine pleurodesis (PIP) through a thoracostomy tube as a palliative treatment of pleural effusion due to metastatic breast carcinoma (MBC). Methods: A total of 42 MBC patients were prospectively enrolled in a randomized controlled trial. Twenty-two patients received TTP (group A), whereas 20 patients (group B) underwent pleurodesis by instilling povidone–iodine through a thoracostomy tube, as a bedside procedure. Results: The mean age was 48.2±9.9 (range: 29–64) years and 50.2±7 (range: 32–62) years for groups A and B, respectively (p =ns). At presentation, all patients had moderate to severe dyspnea, New York Heart Association (NYHA)>II and Medical Research Council (MRC) dyspnea scale 3–5. Morbidity in both groups was low. Post-procedure analgesic requirements due to severe pleuritic chest pain were higher in group A (18% vs 0%, p =0.2). Four patients in group A (18%) and one in group B (5%) were febrile (>38°C) within 48h of the procedure. Both groups achieved good symptom control, with improvement in MRC dyspnea scale (1–3). There were no in-hospital deaths. Post-procedure hospital stay was lower in group B (p =0.009). The mean progression-free interval was 6.6 (range 3–15) months. At follow-up (mean: 22.6 (range: 8–48) months), recurrence of significant pleural effusion requiring intervention was noted in two and three patients in group A and group B, respectively (p =ns). Conclusion: Povidone–iodine can be considered as a good alternative to TTP to ensure effective pleurodesis for patients with malignant pleural effusion due to MBC. The drug is available, cost effective and safe, can be given through a thoracostomy tube and can be repeated if necessary.


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