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

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 recurrence rates, 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 risk of recurrent pleural effusions was observed between TS and TTI groups (RR 0.72; 95 % CI 0.50-1.05; Q statistic, 3.58). 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 MPE recurrence based on patient centered outcomes between talc poudrage and talc slurry treatments.  Respiratory complications are more common with talc poudrage via thoracoscopy.