Pleurodesis success rate for malignant pleural effusions - talc slurry vs. poudrage

Abstract

Introduction: Talc pleurodesis remains the mainstay of treatment for malignant pleural effusions (MPE). We sought to establish the efficacy of talc slurry (TS) and poudrage (TP) and whether this differs by tumour type. Method: A retrospective cohort analysis of MPE patients undergoing 4g Steritalc thoracoscopic TP (Jan 2006-Dec 2013) and TS (Jan 2012-March 2015) using electronic hospital records and archived radiology. Primary endpoint was pleurodesis success among patients alive at approximately 1 and 3 months. Success was defined as absence of a repeat pleural procedure and/or fluid re-occupying Results: Overall, TP demonstrated greater success rate at 1 month compared to TS (85% vs 68% p=0.01) with no difference at 3 months (77% vs 88% p=0.21). For TS there was no significant difference in success between thoracic and non-thoracic MPE at 1 or 3 months. For TP 1 month success was higher for non-thoracic compared to thoracic (91% vs 83%) MPE, but similar for both at 3 months (77%). TP had greater success than TS for non-thoracic MPE at 1 month (91% vs 65% p=0.02) but no difference for thoracic MPE (83% vs 73% p=0.26). Mortality at 3 months was 44% among the TS cohort. Conclusion: TP may be more effective than TS at 1 month and better for patients with good performance status and with a non-thoracic related MPE at 1 month. We acknowledge that studies are seeking to investigate the optimal management of MPE.