Povidone-iodine versus bleomycin pleurodesis for malignant effusion in bronchogenic cancer guided by thoracic echography

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. 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]. 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. lntra-pleural 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 intrapleural instillation of bleomycin or povidone-iodine in a randomized prospective comparative study. Among bleomycin group [no.=26]. echography showed excellent pleurodesis [no.= 21], effective pleurodesis [no.= 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 [no.=25] excellent pleurodesis [no.=20], effective [no.=2] and weak pleurodesis.[no.=3]. The six cases with weak pleurodesis 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. 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.