Effusion Following Pleurodesis: Is There a Difference Between Use of Povidone-Iodine or Cyclophosphamide?
Ogunrombi AB1, Onakpoya UU1, Ekrikpo U2, Aderibigbe AS1, Aladesuru OA1
Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
Department of Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
Correspondence to: Dr. Akinwumi B. Ogunrombi, Postal Code 220005, Ile-Ife, Osun State, Nigeria. Email:firstname.lastname@example.org
Background: Malignant pleural effusion is associated with poor quality of life. The success of pleurodesis varies with different agents, with talc being the most effective. It is however not available in Nigeria. This study aimed to determine the efficacy of povidone iodine and cyclophosphamide, the two commonly available agents for pleurodesis Methods: A prospective simple randomized enrollment of consecutive patients with malignant pleural effusion over a five year period (2008- 2012). Results: Thirty four patients were analyzed with a M:F ratio of 1:2.4. Breast cancer was responsible for almost half (47.1%) of the effusions. Although the povidone iodine group was slightly younger both groups were similar. There was no difference in the effusion recurrence for both groups. Age, duration of symptoms and cancer type were not predictors of recurrence of effusion following pleurodesis. Conclusions: Both agents are readily available and perform well with minimal side effects. However, povidone iodine being cheaper may be a more affordable alternative.
Key Words: Malignant effusion, Pleurodesis, Povidone-iodine, Cyclophosphamide
Malignant pleural effusions are a cause of significant morbidity and mortality in patients at an advanced stage of disseminated neoplastic disease. These patients have a poor quality of life with dyspnea, cough and chest pain. Although this suggests end stage disease with very short life expectancy, prompt, well judged and skilled management of the effusion can alleviate breathlessness and improve quality of life (1). Malignant effusions arise from primary or secondary tumors in the pleura, with majority arising from metastatic sources. Lung and breast tumors account for about 75% of metastatic sources while lymphomas, gastric and ovarian cancers amongst others are responsible for the remaining 25% (2,3). Pleurodesis results in obliteration of the pleural space as a result of formation of fibrous adhesions between the parietal and visceral pleura. These adhesions can be created either by mechanical abrasion or chemical means with varying rates of success (4). An ideal agent for pleurodesis must be highly effective, easy to administer, safe, inexpensive and readily available (5). Talc, the most widely used agent for pleurodesis is not readily available in Nigeria and is therefore, expensive to procure (5,6). Povidone iodine, a commonly available topical antiseptic, has been shown to be safe and effective when used for pleurodesis (7,8). Anti neoplastic drugs eg bleomycin have been utilized successfully for pleurodesis and it is on this basis that cyclophosphamide, another commonly employed anti neoplastic agent used as systemic chemotherapy especially in breast cancer has been employed for pleurodesis in our centre albeit anecdotally (5,9). Its use as an agent for pleurodesis has been previously documented in Nigeria, although it has not been compared with povidone iodine, another readily available agent (10). This study aimed at comparing the time to recurrence of effusion with these two affordable, available and relatively safe agents