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 prospectivelyenrolled in a randomized controlled trial. Twenty-two patientsreceived TTP (groupA), whereas 20 patients(group B) underwentpleurodesisbyinstillingpovidone—iodinethrougha thoracostomytube,asabedsideprocedure.Results:Themeanagewas48.2 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, NewYork Heart Association(NYHA) > II and MedicalResearch Council(MRC)dyspnea scale3—5. Morbidityin both groupswas 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 8C) 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). Conclusion: Povidone—iodine can be consideredasa goodalternativeto TTPto ensure effectivepleurodesisfor patientswith malignantpleural effusiondue to MBC. Thedrug is available, cost effective and safe, can be given through a thoracostomy tube and can be repeated if necessary. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.