Abstract
BackgroundTalc 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.MethodsPubMed, 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.ResultsTwenty 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).ConclusionsThe 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.
Highlights
Malignant pleural effusion (MPE) is a common complication of advanced malignancy with a poor prognosis
20 articles were available for analyzing the efficacy or/and safety of talc pleurodesis for MPE [28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47] (Figure 1), and all the articles were the reports of randomized controlled trials except for two [42,43]
Our meta-analysis revealed that no significant difference was observed at 1 m (RR, 0.94; 95% confidence intervals (CI), 0.80–1.11; p = 0.455; random-effects model); in contrast, talc pleurodesis was more effective than control therapies (RR, 1.35; 95% CI, 1.07–1.69; p = 0.010; random-effects model) at longer than 1 m (Table 2)
Summary
Malignant pleural effusion (MPE) is a common complication of advanced malignancy with a poor prognosis. Progressive dyspnea is the most common symptom in patients with MPE followed by cough and chest pain that affect the quality of life [2]. Some malignancies such as small cell lung cancer, lymphoma, or breast cancer might respond to systemic treatment, local therapy for MPE may still be needed [3]. Local palliative procedures are more required to relieve dyspnea, improve life quality, and avoid repeated thoracentesis for patients not responding to systemic treatment [4]. We performed a meta-analysis to evaluate the efficacy and safety of talc pleurodesis in the management of malignant pleural effusion
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