Prospective randomized comparison of thoracoscopic talc poudrage under local anesthesia versus bleomycin instillation for pleurodesis in malignant pleural effusions

Induction of pleurodesis offers benefit for patients with metastatic tumors and symptomatic malignant pleural effusions, but the best method for achie ving this is still unknown. In this prospective, randomized comparison of t wo well-established pleurodesis procedures, 36 patients with malignant pleu ral effusions, expanded lungs after drainage, and expected survival of > 1 mo received either bleomycin instillation (60E) via a small-bore thoracosto my tube or thoracoscopic talc poudrage (5 g) under local anesthesia. Effica cy, safety, and cost could be evaluated for 32 treatments (17 bleomycin, 15 talc) in 31 patients. Recurrence rates of effusion with bleomycin and talc poudrage after 30 d were 41% and 13% (p = 0.12), respectively, those after 90 d were 59% and 13%, respectively (p = 0.01), and those after 180 d were 65% and 73% (p = 0.005), respectively. Neither procedure showed any major adverse effect, and both were equally well tolerated. Cost estimation favor ed thoracoscopic talc poudrage, both for the initial hospitalization and wi th regard to recurrences. In conclusion, thoracoscopic talc pleurodesis und er local anesthesia is superior to bleomycin instillation for pleurodesis i n cases of malignant pleural effusion.