Pleural effusion: pleurodesis: no clear difference between talc slurry and bleomycin.

Clinical bottom line (level 1b-)

Talc slurry was probably as effective as bleomycin for pleurodesis in patients with malignant pleural effusions, and was far cheaper.

Zimmer et al: Chest 1997; 112 (2): 430-434

Expires October 2003

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: acute hospital, USA

35 patients (aged mean 67 years, 67% female) malignant pleural effusions (proven by cytology or biopsy)

Excluded if

life expectancy <1 month

Note:

29 patients underwent 33 procedures.

Control Group: (n = , 14 analysed): bleomycin 60 units in 50 ml normal saline
Experimental Group: (n = , 19 analysed): talc 5 g in 50 ml normal saline
Most patients had a chest tube inserted (28-French) using local anaesthesia; two had the pleurodesis performed under limited thoracotomy. The sclerosing agent was instilled for two hours with the patient rotating every 10-15 minutes.
83% followed for mean1.7 months
Outcome notes:

recurrence : partial or complete

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
recurrence	1.7 months	3 (21.4%)	2 (10.5%)	51% (-156% to 91%)	10.9% (-14.6% to 36.4%)	9 (NNT = 3 to infinity; NNH = 7 to infinity)

Talc was notably cheaper than bleomycin ($12 v. $955).

Comments

The study was too small to show any clear difference between talc and bleomycin.

Citation

Zimmer PW, Hill M, Casey K, et al: prospective randomized trial of talc slurry vs bleomycin in pleurodesis for symptomatic malignant pleural effusions. Chest 1997; 112 (2): 430-434

Search Terms: pleural effusion in Cochrane
Contributor: Chris Ball and Clare Wotton, October 2000
Reviewer:

_{Clinical Question.}

_Patient	_{malignant pleural effusion}
_{Intervention or Exposure}	_{talc slurry}
_Comparison	_bleomycin
_Outcome	_recurrence