Talc pleurodesis in malignant pleural effusion: a systematic review and meta-analysis
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ORIGINAL ARTICLE
Talc pleurodesis in malignant pleural effusion: a systematic review and meta‑analysis Eleftherios T. Beltsios1,2 · Georgios Mavrovounis2 · Antonis Adamou2,3 · Nikolaos Panagiotopoulos1 Received: 15 October 2020 / Accepted: 6 November 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective Malignant pleural effusion is a severe and common complication in patients with primary or metastatic malignancies of the pleura. Although talc pleurodesis is widely used for managing malignant pleural effusions, there is still controversy in the literature regarding its superiority compared to other approaches. We conducted this meta-analysis to further investigate its efficacy compared to alternative interventions. Methods We systematically reviewed the PubMed, Cochrane, and Scopus databases to identify studies that fulfilled our inclusion criteria. Study quality was evaluated using validated tools and the pooled Risk Ratio (RR) and confidence interval (CI) were calculated. We performed sensitivity analyses based on the meta-analysis method and type of study. Results Twenty-four studies were included in the current systematic review meta-analysis. Talc pleurodesis was associated with statistically significant higher successful pleurodesis rates when compared with all controls [RR (95% CI) 1.15 (1.00, 1.31); Pz = 0.04], only chemical controls [RR (95% CI) 1.26 (1.13, 1.40); Pz 1-month follow-up time point favored talc pleurodesis [RR (95% CI): 1.62 (1.15, 2.27); P z = 0.005]. Finally, talc poudrage was associated with a statistically significant higher successful pleurodesis rate when compared with all controls. Sensitivity analyses verified the robustness of our results. Conclusion Talc pleurodesis is an effective MPE management approach presenting borderline statistically significant superiority compared to control methods especially compared to bleomycin as well as when pleurodesis success is evaluated later than 1 month postoperatively. Keywords Talc pleurodesis · Chemical pleurodesis · Ipcs · Malignant pleural effusions · Meta-analysis
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-020-01549-2) contains supplementary material, which is available to authorized users. * Eleftherios T. Beltsios [email protected] 1
Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
2
Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Biopolis, Greece
3
Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
Malignant pleural effusions (MPEs) are a common complication presented mostly in patients with progressive malignancies. [1, 2] In fact, there is evidence that more than 150.000 MPE cases are reported only in the US every year. [3, 4] The leading causes of MPEs appear to be lung and breast cancer, [5, 6] lymphoma as well as ovarian and gastric carcinoma. [7] The increased pleu
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