புற்றுநோய் அறிவியல் & சிகிச்சை

Povidone- Iodine versus Bleomycin Pleurodesis for Malignant Effusion in Bronchogenic Cancer Guided by Thoracic Echography

Abstract

Hamdy D Elayouty, Tarek M Hassan and Zain A Alhadad

Objectives: This study was designed to compare effectiveness of intra-pleural instillation of Bleomycin with instillation of Povidone-iodine for control of malignant pleural effusion among patients with non-small cell lung cancer, guided by results of thoracic Echography. Methods: Fifty one patients had the possibility of full lung expansion. Drainage of the effusion was followed by instillation of bleomycin or povidone- iodine through the thoracostomy tube. Four weeks after discharge, thoracic echography was performed and repeated 4 weeks later. Follow-up ranged between 4–32 months (mean: 21 ± 3.5 months). Results: We received 79 patients with malignant pleural effusion as stage IV non-small cell lung cancer during the last four years. Seventeen patients had centrally-located tumors with persistent lung atelectasis. Intrapleural injection of streptokinase to breakdown intra-pleural fibrinous adhesions was carried out in 9 cases; and was successful in 6 cases 66% (6/9). Finally, 54 patients had an evidence of possible lung expansion but three died before pleurodesis. Thus, 51 patients received intra-pleural instillation of bleomycin or povidone-iodine in a randomized prospective comparative study. Among bleomycin group (n = 26), echography showed excellent pleurodesis (n = 21), effective pleurodesis (n= 2) with one or two areas of free mobility and one area of fluid component, weak pleurodesis (no. = 3) with three areas of free lung movement (lung sliding sign) and areas of fluid component. Among povidone-iodine group (n= 25) excellent pleurodesis (no. = 20), effective (n= 2) and weak pleurodesis (n= 3). The six cases with weak pleurodisis in both groups were those who had streptokinase before pleurodesis. Complications and hospital stay were comparable for both groups. Chest X-ray proved recurrence of effusion in the six cases with weak pleurodesis after symptom-free intervals that varied between 4 and 6 weeks among these 6 patients. Conclusions: Both bleomycin and povidone-iodine produced comparable excellent and effective pleurodesis among patients with malignant pleural effusion. The cost is much lower with povidone-iodine.