Malignant Pleural Effusion Clinical Trial
Official title:
Efficacy of Iodopovidone Versus Talc in Palliative Malignant Pleural Effusion: a Randomized Controlled Trial Study
This is prospective randomized control trial study. The aim of this study is to evaluate the efficacy of Iodopovidone solution for pleurodesis in palliative malignant pleural effusion (MPE) patients comparing to Talc. All adult patients who diagnosed MPE by cytology regardless primary tumor between December 1, 2015 and November 29, 2016 at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand will be enrolled in this study. The inform and consent will be applied in all patients before treatment. Patients will be randomized to two groups; Iodopovidone group (intervention group) and Talc group (control group)
Background and Rationale: Malignant pleural effusion (MPE) defined as presenting malignant
cell in pleural effusion. It is usually found in advanced stage cancer or cancer of pleura.
Most common primary tumor causing MPE is lung cancer (37%) followed with breast cancer (16%).
From previous studies, when MPE was diagnosed, the median survival was only 3-12 months
depending on primary tumor. In lung cancer, median survival for stage IV with MPE was only 4
months. However, quality of life of patient is also important. These patients should have
less suffer from MPE. In recent era, chemotherapy, targeted therapy and immunotherapy are
very useful for advanced stage cancer patients. They can prolong survival in such patients.
Therefore, pleurodesis had role for palliative treatment hoping these patient have better
quality of life. Talc (composed of oxygen, silicate, magnesium and carbon) has been used as
one of common substances for chemical pleurodesis since 1935 by Norman Bethune with high
efficacy (90%). However, it can cause a serious complication such as acute respiratory
distress syndrome (ARDS). Although an incidence of ARDS is not too high, it can make patients
died, therefore, other substances have been studied instead of using Talc. Iodopovidone has
been one of interesting substances used as pleurodesis substance since 2006. It is low cost,
and available. One meta-analysis of 13 observational studies with 499 patients found that
iodopovidone was safe with success rate of pleurodesis was 70-100%. The most common side
effect was chest pain. Previously, only two randomized control trial studies reported the
efficacy of iodopovidone solution comparing to Talc for pleurodesis. They found that there
were no statistical significant difference either efficacy or safety between two substances.
The limitation of those studies is small sample size, therefore, we would like to compare the
efficacy of iodopovidone solution for chemical pleurodesis with Talc.
Objectives: To compare the efficacy of Iodopovidone solution with Talc for pleurodesis in MPE
Research methodology: This is a prospective randomized control trial. All adult patients who
diagnosed MPE by cytology regardless primary tumor between December 1, 2015 and November 29,
2016 at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand will
be enrolled in this study. Patients will be randomized to two groups; Iodopovidone group
(intervention group) and Talc group (control group). The efficacy of both groups will be
compared.
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