Thoracoscopic pleurodesis using talc poudrage versus cytotoxic drug in malignant pleural effusion: Narrative review

Abstract

Malignant pleural effusion (MPE) indicates incurable cancer with a variable prognosis, from 4 to 12 months. Definitive control of effusion with pleurodesis should be undertaken in all patients with an expandable lung who are likely to require frequent drainages and with an expected survival greater than 3 months. Presently, talc is the most commonly used pleurodesis agent. It is inexpensive and readily available worldwide. Its superiority over alternative compounds has been suggested by more than one meta-analysis; thus, it is the agent of choice in the international guidelines. Talc is highly effective, with success rates from 80% to 95%, relative to the dose, number of administrations and patient’s metabolic and nutritional conditions, with acceptable side effects and risks in a patient with a modest life expectancy. Other substances used are tetracyclines (doxycycline, minocycline), bleomycin, nitrogen mustards, quinacrine, Corynebacterium parvum, interferon (IFN), methylprednisolone, doxorubicin, cisplatin, cytarabine, etoposide, fluorouracil, mitomycin C, gold-and phosphorus-radioactive isotopes, alcohol, povidone-iodine and silver nitrate. Talc remains the most effective sclerosant available for pleurodesis. There are no comparative studies showing the superiority of other substances to talc. Talc poudrage is highly effective, at least equivalent to talc slurry, with possible increased efficacy in certain disease subgroups. The lack of comparative randomized trials, different eligibility criteria and heterogeneity of the study populations do not help scientists determine the standards concerning the type of substance to be used, indications, and methods.