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. 2014 Oct 27:3:254.
doi: 10.12688/f1000research.5538.2. eCollection 2014.

Malignant pleural effusions and the role of talc poudrage and talc slurry: a systematic review and meta-analysis

Srinivas Mummadi  1 , Anusha Kumbam  2 , Peter Y Hahn  1
Affiliations

Malignant pleural effusions and the role of talc poudrage and talc slurry: a systematic review and meta-analysis

Srinivas Mummadi et al. F1000Res. .

Abstract

Background: Malignant Pleural Effusion (MPE) is common with advanced malignancy. Palliative care with minimal adverse events is the cornerstone of management. Although talc pleurodesis plays an important role in treatment, the best modality of talc application remains controversial.

Objective: To compare rates of successful pleurodesis, rates of respiratory and non-respiratory complications between thoracoscopic talc insufflation/poudrage (TTI) and talc slurry (TS).

Data sources and study selection: MEDLINE (PubMed, OVID), EBM Reviews (Cochrane database of Systematic Reviews, ACP Journal Club, DARE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database), EMBASE and Scopus. Randomized controlled trials published between 01/01/1980 - 10/1/2014 and comparing the two strategies were selected.

Results: Twenty-eight potential studies were identified of which 24 studies were further excluded, leaving four studies. No statistically significant difference in the probability of successful pleurodesis was observed between TS and TTI groups (RR 1.06; 95 % CI 0.99-1.14; Q statistic, 4.84). There was a higher risk of post procedural respiratory complications in the TTI group compared to the TS group (RR 1.91, 95% CI= 1.24-2.93, Q statistic 3.15). No statistically significant difference in the incidence of non-respiratory complications between the TTI group and the TS group was observed (RR 0.88, 95% CI= 0.72-1.07, Q statistic 4.61).

Conclusions: There is no difference in success rates of pleurodesis based on patient centered outcomes between talc poudrage and talc slurry treatments. Respiratory complications are more common with talc poudrage via thoracoscopy.

Keywords: malignant pleural effusion; palliation; pleurodesis.

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Conflict of interest statement

Competing interests: No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. Flowsheet of study selection process.
Figure 2.
Figure 2.. Pooled relative risks (RRs) of success rates post talc pleurodesis.
RR, risk ratio, CI, confidence interval.
Figure 3.
Figure 3.. Filled funnel plot using the trim and fill method for succesful pleurodesis rates post talc pleurodesis: imputed studies - ●, observed studies - ○, CI – confidence interval.
Figure 4.
Figure 4.. Pooled relative risks (RRs) for respiratory complications post talc pleurodesis.
RR, risk ratio, CI, confidence interval.
Figure 5.
Figure 5.. Filled funnel plot using the trim and fill method for risk of respiratory complications: imputed studies - ●, observed studies - ○, CI – confidence interval.
Figure 6.
Figure 6.. Pooled relative risks (RRs) for non-respiratory complications post talc pleurodesis.
RR, risk ratio, CI, confidence interval.
Figure 7.
Figure 7.. Filled funnel plot using the trim and fill method for risk of non-respiratory complications: imputed studies - ●, observed studies - ○, CI – confidence interval.
See this image and copyright information in PMC

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