The evidence on the effectiveness of management for malignant pleural effusion: a systematic review

Tan, Carol; Sedrakyan, Artyom; Browne, John; Swift, Simon; Treasure, Tom
May 2006
European Journal of Cardio-Thoracic Surgery;May2006, Vol. 29 Issue 5, p829
Academic Journal
Summary: The aim of this study was to review systematically the available evidence on pleurodesis for malignant effusion, focusing on the choice of the agents, route of delivery and other strategies to improve outcomes. Four electronic databases (MEDLINE, EMBASE, Web of Science and Cochrane Controlled Trials Register) were searched, reference lists checked and letters requesting details of unpublished trials and data sent to authors of previous trials. Studies of malignant pleural effusion in humans were selected with no language restrictions applied. Criteria for randomised clinical trial (RCT) eligibility were random allocation of patients and non-concurrent use of another experimental medication or device. Methodological quality evaluation of the trials was based on randomisation, blinding, allocation concealment and intention to treat analysis. A random effect model was used to combine the relative risk estimates of the treatment effects whenever pooling for an overall effect was considered appropriate. Forty-six RCTs with a total of 2053 patients with malignant pleural effusions were reviewed for effectiveness of pleurodesis. Talc tended to be associated with fewer recurrences when compared to bleomycin (RR, 0.64; 95% CI, 0.34–1.20) and, with more uncertainty, to tetracycline (RR, 0.50; 95% CI, 0.06–4.42). Tetracycline (or doxycycline) was not superior to bleomycin (RR, 0.92; 95% CI, 0.61–1.38). When compared with bedside talc slurry, thoracoscopic talc insufflation was associated with a reduction in recurrence (RR, 0.21; 95% CI, 0.05–0.93). Strategies such as rolling the patient after instillation of the sclerosing agent, protracted drainage of the effusion and use of larger chest tubes were not found to have any substantial advantages. Talc appears to be effective and should be the agent of choice for pleurodesis. Thoracoscopic talc insufflation is associated with fewer recurrences of effusions compared with bedside talc slurry, but this is based on two small studies. Where thoracoscopy is unavailable bedside talc pleurodesis has a high success rate and is the next best option.


Related Articles

  • Fibrinolytic treatment of complicated pediatric thoracic empyemas with intrapleural streptokinase Ekingen, Gülşen; Güvenç, Bekir H.; Sözübir, Selami; Tuzlacı, Ayşe; Şenel, Ufuk // European Journal of Cardio-Thoracic Surgery;Sep2004, Vol. 26 Issue 3, p503 

    Objective: Proper antibiotic treatment and adequate pleural drainage is essential in successful management of pleural effusions. In complicated effusions the increased production of fibrin results in formation of loculations and septations within the thoracic cavity, leading ineffective chest...

  • Pleural disease.  // Thorax;Dec2004 Supplement, Vol. 59, p39 

    The article presents abstracts of papers on the clinical aspects of pleural disease. One of the studies report that malignant pleural effusion is a frequent complication of metastatic disease. Management of effusion often involves drainage followed by medical pleurodesis. Talc, tetracycline, and...

  • SEMI-RIGID THORACOSCOPY FOR DIAGNOSING PLEURAL DISEASES AND TALC PLEURODESIS. Rozman, Ales; Camlek, Luka; Malovrh, Mateja Marc; Kern, Izidor // Turkish Respiratory Journal / Solunum Dergisi;2013 Supplement, Vol. 15, p3 

    Aim: Thoracoscopy with a semi-rigid instrument is a recent technique for diagnosing pleural diseases. The purpose of this study was to report diagnostic yield and complications of the method. Materials and Methods: Patients with pleural effusion of unknown origin and/or pleural irregularities...

  • Intrapleural streptokinase for pleural infection.  // BMJ: British Medical Journal (International Edition);1/21/2006, Vol. 332 Issue 7534, p133 

    The article presents the author's views on parapneumonic pleural effusions and pleural empyema. The symptoms of each condition are reviewed. The results of clinical studies related to each condition are reviewed. The author discusses a study of the issue by N. A. Maskell in colleagues, published...

  • Potential role of matrix metalloproteinase-2,-9 and tissue inhibitors of metalloproteinase-1,-2 in exudative pleural effusions. Vatansever, S.; Gelisgen, R.; Uzun, H.; Yurt, S.; Kosar, F. // Clinical & Investigative Medicine;Aug2009, Vol. 32 Issue 4, pE293 

    Purpose: To investigate diagnostic values of pleural fluid matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitors of metalloproteinase-1 (TIMP-1) and TIMP-2 measurements in tuberculous pleurisy(TP) and malignat pleurisy (MP). Methods: The study included 24 patients with TP, 22 patients...

  • Pleuropulmonary Blastoma: A Case Report. Hammad, Abdelmohsen M.; Serag, Amr R.; Bayoumi, Shereif L. // Internet Journal of Thoracic & Cardiovascular Surgery;2003, Vol. 6 Issue 2, p90 

    Pleuropulmonary blastoma (PPB) is a rare and aggressive malignant tumor that affects children. We present a case of pleuropulmonary blastoma in a 16-month-old male baby who was referred to our department due to apparently right side encysted pleural effusion. Chest CT depicted a large cystic...

  • The Occurrence Of Pleural Effusion Secondary To Ovarian Fibroma. Kant, Surya; Verma, Sanjay Kumar; Verma, Rajendra // Internet Journal of Pulmonary Medicine;2009, Vol. 10 Issue 2, p7 

    The association of pleural effusion and ascitis, secondary to ovarian tumor, are considered to be uncommon clinical condition. Hereby we reported a case of 43 years old female presented as right sided pleural effusion and ascitis secondary to ovarian fibroma and after removal of ovarian tumor...

  • Pleural effusion - An unusual cause. Vinoth, Ponnurangam Nagarajan; Anitha, Palaniyadi; Muthamilselvan, Sathyamoorthi; Sasitharan, Rajendraprasath; Shuba, Sankaranarayan; Rajakumar, Padur Sivaraman; Scott, Julius Xavier // Australasian Medical Journal;2012, Vol. 5 Issue 7, p113 

    Hepatitis A (HAV) infection is one of the most common forms of hepatitis in the paediatric age group in developing countries. It is usually self-limiting and rarely accompanied by extra hepatic complication. In this article, we report two children with hepatitis A who had associated issues of...

  • Cytopathologic Diagnosis in Pleural Effusion and Cyto-Histopathologic Correlation. Dağli, Adile Ferda; Küçük, Şirin; Sezer, Müge; Üçer, Özlem // Turkish Journal of Pathology;2011, Vol. 27 Issue 1, p12 

    Objective: Cytological examination of pleural fluids is a fast, efficient and non-invasive diagnostic method. Identification of malignant effusions bears critical importance in treatment and prognosis. The aim of this study was to investigate the distribution of cytopathologic diagnoses in...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics