Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis.
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.
Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.
Huan
H
Xia
Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.
Xiao-Juan
XJ
Wang
Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Qiong
Q
Zhou
Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China ; Center of Medical Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Huan-Zhong
HZ
Shi
Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.
Zhao-Hui
ZH
Tong
D006801:Humans; D015233:Models, Statistical; D016066:Pleural Effusion, Malignant / Q000188:drug therapy*; D018700:Pleurodesis / Q000379:methods / Q000592:standards*; D012306:Risk; D013627:Talc / Q000627:therapeutic use*
D013627:Talc