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


CONCLUSIONS
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.
Department of Cardiothoracic Surgery, Kasr El Aini Hospital, Cairo University Hospitals, El Manial, Egypt.
Tarek A
TA
Mohsen
Amany A Abou
AA
Zeid
Mohamed
M
Meshref
Nehad
N
Tawfeek
Karen
K
Redmond
Olga G
OG
Ananiadou
Saleem
S
Haj-Yahia
D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D001943:Breast Neoplasms / Q000150:complications; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D016066:Pleural Effusion, Malignant / Q000150:complications / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods*; D011206:Povidone-Iodine / Q000008:administration & dosage*; D011446:Prospective Studies; D012008:Recurrence; D013627:Talc / Q000627:therapeutic use*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D016896:Treatment Outcome
D013627:Talc; D011206:Povidone-Iodine