Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis

Abstract

Background: Talc pleurodesis has been widely used to control malignant pleural effusion; however, it is still not clear whether talc pleurodesis is more effective than other local therapies. We performed a meta-analysis to evaluate the efficacy and safety of talc pleurodesis in the management of malignant pleural effusion.

Methods: PubMed, Embase, and Web of Science were searched for English-language studies of clinical controlled trials comparing talc pleurodesis with control therapies until August 8, 2013. Success rate and incidence of adverse events were evaluated. Relative risks were estimated using random- or fixed- effects model and statistical heterogeneity was assessed using I² test.

Results: Twenty trials involving 1,525 patients with malignant pleural effusion were included. The success rate of talc pleurodesis was significantly higher than that of control therapies (relative risk, 1.21; 95% confidence interval, 1.01-1.45; p = 0.035) with similar adverse events. In addition, thoracoscopic talc poudrage was more effective than bedside talc slurry (relative risk, 1.12; 95% confidence interval, 1.01-1.23; p = 0.026).

Conclusions: The current evidences suggested the benefit for talc pleurodesis in the treatment of malignant pleural effusion. Talc pleurodesis, especially thoracoscopic talc poudrage pleurodesis, should be performed in patients with malignant pleural effusion, especially those with life-expectancy longer than one month.

Figure 1. A flow chart showing the progress of trials through the review.

Figure 2. Meta-analysis of the relative risks (RR) of success rate between talc pleurodesis and control therapies using random-effects model.

Bars represent 95% confidence intervals (CI) of RR in patients receiving talc pleurodesis versus controls. The center of the lozenge gives the combined RR. RR was considered statistically significant if the 95% CI for the overall RR does not overlap one.

Figure 3. Funnel graph for the assessment of potential publication bias in talc pleurodesis compared with control therapies for malignant pleural effusion.

The funnel graph plots log of relative risk (RR) against the standard error of the log of RR. Each solid circle represents each study in the meta-analysis. The line in the center indicates the summary RR.