Outcome of pleurodesis using different agents in management of malignant pleural effusion

Introduction: Malignant pleural effusion is a serious problem for both patients and physicians. Pleurodesis is considered the good solution for this dilemma. Chemical pleurodesis was used to prevent fluid reaccumulation and decrease patient suffering. This study was designed to compare and evaluate the efficacy and safety of three different sclerosing agents for preventing recurrent malignant pleural effusion. Materials and methods: Forty five patients with recurrent malignant pleural effusion were enrolled in three groups; 15 patients in each one, and were subjected to pleurodesis using three chemical agents. Vincristine (2 mg), viscum (100 mg) and povidone–iodine (20 ml). All patients were subjected to the thoracotomy tube for drainage of pleural fluid, then sclerosing agents were instilled intrapleurally via the tube. Results: Vincristine, viscum and povidone–iodine resulted in complete pleurodesis in 53.3%, 73.3% and 73.3% respectively. Failed pleurodesis was higher in the vincristine group 26.7% but in viscum and iodine groups were 13.3% and 20% respectively. Pain was the most common complication 48.89% and reported in a higher ratio in the vincristine group 66.67%, while in viscum and iodine groups it was 53.33% and 26.67% respectively. There was no statistically significant difference between the three groups regarding pleural fluid chemistry and duration of ICT. Conclusion: According this study, povidone iodine is considered the ideal sclerosing agent for pleurodesis in comparison to vincristine and viscum because of its high efficacy, availability, cheapness and least side effects