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). 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.