Malignant pleural effusions and the role of talc poudrage and talc slurry: a systematic review and meta-analysis [version 2; referees: 2 approved, 1 approved with reservations]

Malignant Pleural Effusion (MPE) is common with advanced Background: 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. To compare rates of successful pleurodesis, rates of respiratory Objective: and non-respiratory complications between thoracoscopic talc insufflation/poudrage (TTI) and talc slurry (TS). MEDLINE (PubMed, OVID), EBM Data sources and study selection: 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. Twenty-eight potential studies were identified of which 24 studies Results: were further excluded, leaving four studies. No statistically significant difference in the probability of successful pleurodesis was observed between TS and TTI groups (RR 1.06; 95 % CI 0.99-1.14; Q statistic, 4.84). 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). There is no difference in success rates of pleurodesis based on Conclusions: patient centered outcomes between talc poudrage and talc slurry treatments. Respiratory complications are more common with talc poudrage via thoracoscopy. 1,2 1,3