Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis

Our plain-English summary of Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis, by M. Yeung, E.W. Loh, T.Y. Tiong, et al (Clinical & Experimental Metastasis, 2020).

The study

• Authors: M. Yeung, E.W. Loh, T.Y. Tiong, K.W. Tam
• Journal: Clinical & Experimental Metastasis
• Published: 2020;37(4):541-549
• Type of article: Meta-analysis
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural effusion (MPE) results from primary mesothelioma or the spreading of metastatic cancer. Both talc pleurodesis (TP) and indwelling pleural catheter (IPC) improve MPE symptoms. We performed a meta-analysis of randomized controlled trials to compare the efficacy of TP with that of IPC in patients with MPE. PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases were searched for studies published before February 2020. Individual effect sizes were standardized, and a meta-analysis was conducted to calculate a pooled effect size by using random effects models. In total, 4 trials with 500 patients were reviewed. Difference in pleurodesis success rate and change in dyspnea scores at 4 and 6 weeks between MPE patients treated with IPC and those treated with TP for pleurodesis were nonsignificant. The number of hospital inpatient days was significantly lower among patients who were treated with IPC (weight mean difference: 2.19; 95% confidence interval 0.70-3.67) than among those who were treated with TP. No significant difference was shown in adverse event profile between patients treated with IPC and those treated with TP for pleurodesis. In conclusion, both TP and IPC are equally effective in treating patients with MPE. The number of hospitalization days was significantly lower for patients who were treated with IPC, but the magnitude of the difference is of uncertain clinical importance.

In plain English

This meta-analysis pooled four randomized controlled trials, published 2012 to 2018, of 500 patients with malignant pleural effusion, a build-up of fluid around the lung caused by cancer. Three trials compared an indwelling pleural catheter (a tube left in the chest so fluid can be drained) with talc pleurodesis (talc used to seal the space around the lung) given through a chest tube. In the fourth, all patients had a catheter and outpatient drainage for 10 days; those without evidence of substantial lung entrapment were then randomized to talc or placebo through the catheter. The pooled results showed no statistically significant difference between groups in pleurodesis success, breathlessness score change at 4 and 6 weeks, or adverse events, including infection and death. Patients treated with the catheter spent fewer days in hospital (weighted mean difference 2.19 days; 95% confidence interval 0.70 to 3.67). Quality-of-life results could not be pooled. The authors concluded that the shorter hospital stay was of uncertain clinical importance. They noted small samples and high dropout in some trials, and that breathlessness scores are subjective.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Systematic review and meta-analysis of randomized controlled trials, using random-effects models
• Who was studied: 4 randomized controlled trials published 2012 to 2018, totaling 500 adult patients with malignant pleural effusion (cancer types listed as breast, lung or others); trial sizes 94 to 154 patients
• Exposure: Treatments compared, not an asbestos exposure: indwelling pleural catheter (IPC) versus talc pleurodesis (TP). Three trials compared IPC alone with talc given through a chest tube. In one trial (Bhatnagar), all patients had an IPC with outpatient drainage for 10 days. Those with no evidence of substantial lung entrapment were then randomized to talc or placebo given through the catheter.
• Main results:
  • Pleurodesis success rate: no significant difference between the talc pleurodesis and catheter groups (RR 1.04; 95% CI 0.54 to 1.98). One trial was left out of this analysis because it lacked control-group data.
  • Change in breathlessness (dyspnea) score on a 100-point scale, pooled from 3 trials: mean difference -2.16 (95% CI -7.59 to 3.27) at week 4 and -0.42 (95% CI -5.94 to 5.10) at week 6. The difference between groups was not significant.
  • Hospital inpatient days, pooled from 3 trials: the catheter group had a significantly shorter hospital stay than the talc pleurodesis group (WMD 2.19 days; 95% CI 0.70 to 3.67).
  • Adverse events: no significant differences between the groups in infection (RR 0.49; 95% CI 0.12 to 2.02), catheter blockage or loculations (RR 0.42; 95% CI 0.08 to 2.09), pain (RR 0.68; 95% CI 0.33 to 1.44), dyspnea (RR 1.15; 95% CI 0.42 to 3.14) or death (RR 0.83; 95% CI 0.33 to 2.10).
  • Quality of life could not be pooled. Two trials reported no significant difference between groups. One trial (Bhatnagar) reported better quality-of-life scores in the talc pleurodesis group.
• The authors' conclusion: The authors concluded that managing malignant pleural effusion with an indwelling pleural catheter resulted in a significantly shorter hospital stay, but that the size of the difference is of uncertain clinical importance. They found no significant differences in pleurodesis success, breathlessness improvement or adverse events, and considered the catheter one suitable option alongside talc pleurodesis.
• Limitations the authors state:
  • Some trials had small numbers of patients per treatment group, which may reduce statistical power.
  • Some trials had high dropout rates, which could bias the analysis.
  • Quality-of-life data could not be pooled.
  • Outcomes were reported in different ways across trials, and the dyspnea score is self-reported and subjective.
  • There was considerable heterogeneity between trials. Hospital days and pleurodesis success were defined differently across the studies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Indwelling Pleural Catheter, Talc Pleurodesis, Pleural Effusion, Meta-Analysis, Mesothelioma, Pleurodesis, Dyspnea, confidence interval.

Related studies

• Protocol of the Australasian Malignant Pleural Effusion-2 (AMPLE-2) trial: a multicentre randomised study of aggressive versus symptom-guided drainage via indwelling pleural catheters — M. Azzopardi, R. Thomas, et al. (2016)
• Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial — S. Muruganandan, M. Azzopardi, et al. (2018)
• Predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion — E.T.H. Fysh, S. Bielsa, et al. (2015)
• Interventional therapies for malignant pleural effusions: the present and the future — R. Thomas, R. Francis, et al. (2014)
• Survival in patients with malignant pleural effusion undergoing talc pleurodesis — M. Hassan, R.M. Mercer, et al. (2019)
• MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial — C. Matthews, C. Freeman, et al. (2019)

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