Povidone-iodine effectiveness as chemical pleurodesis for malignant pleural effusion in comparison to Bleomycin

Abstract

Author(s): Ahmed Muhi Fahad*, Laith Fathi Flayyh Sharba, Hayder Noaman Rabeea, Ashraf Sami Mohammed, Saja Musafer Abbood and Ahmed Salih Alshewered

Malignant Pleural Effusion (MPE) is occurred in about 15% of all patients with cancer especially in lung cancer. Pleurodesis using Bleomycin and povidoneiodine to palliate symptoms of MPE. This study aimed to compare the efficacy, safety, and outcome of Bleomycin pleurodesis with Povidone-Iodine Pleurodesis (PIP) by injection through a chest tube as a palliative preventive management of recurrent MPE. This is a retrospective cross-sectional cohort study that includes fifty-four patients diagnosed with malignant pleural effusion. The patients were classified into two groups, G1 who received povidone-iodine for pleurodesis (total number 21 patients), and G2 whose received Bleomycin for pleurodesis (total number 33 patients). The mean age of patients in G1 is 62 ± 11.31 years (range from 44-81), while in G2 is 58 ± 10.89 years (range from 43-83). In G1, the total number of males is 13 patients (61.9%) and female patients are 8(38.09%), while in G2, the male patients are 20 (60.6%) and females are 13(39.4%). In G1, there are 11(52.38%) patients with right-side involvement, 9 (24.85%) patients with left-side involvement, and one (4.76%) the patient is bilateral. In G2, there are 15 patients (45.45%) with right side involvement and 18 patients (54.54%) with left side involvement. There are 3 patients (14.28%) who have postoperative chest pain in G1, while in G2, there are 2 patients (6.06%) with postoperative chest pain and 2 patients (6.06%) with fever. All the complications in both groups are subsided gradually over 1^st 1 hours-4 hours later on. The primary tumor in G1 is lung in 9 cases (42.85%), breast in 5 cases (23.8%), colon in 3 cases (14.28%), thyroid in one case (4.76%), prostate in two cases (9.52%) and lymphoma in one case (4.76%). In G2, the primary tumor is lung in 14 cases (42.42%), breast in 7 cases (21.21%), colon in 7 cases (21.21%), lymphoma in 4 cases (12.12%), and prostate in one case (3.03%). Regarding the following three months, the recurrence is present in one case in G1 (4.76%) and 7 cases in G2 (21.21%). The death rate is present in one case in G1 (4.76%) and two cases in G2 (6.06%). In conclusion, the older age and male gender cancerous patients are the more complicated with MPE. Left sided MPE is the common observed. The most postoperative complications are chest pain and fever. Lung cancer is the major cause of MPE over other types of cancer. Povidoneiodine is superior to Bleomycin as a sclerosing agent for pleurodesis because of its cheapness, high efficacy, availability, and least side effects.

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