[A systematic review of talc compared with bleomycin for patients with malignant pleural effusion.]

Malignant pleural effusions are a common complication in advanced malignancy. Talc, bleomycin and the tetracyclines are the three most frequently used sclerosants. The aim of this study is to evaluate the efficacy and adverse effects of patients with malignant pleural effusions treated with talc and bleomycin.

We searched PubMed, Embase, the Cochrane Library, Chinese biomedicine literature database (CBM), CNKI, VIP, references of included studies for randomized controlled trials comparing talc with bleomycin for patients with malignant pleural effusions. The quality of included studies was assessed independently by two reviewers, discrepancies were resolved by discussion with the third person. We analyzed the data using Review Manager (version 5.0) software.

Six studies totaling 224 patients were included. Meta analysis results were as follows: there was significant difference in treatment success (RR=1.22, 95%CI: 1.05-1.42), recurrence rate (RR=0.31, 95%CI: 0.11-0.87) between talc group and bleomycin group, there was no significant difference between the two groups in case fatality rate (RR=1.39, 95%CI: 0.84-2.30), fever (RR=0.68, 95%CI: 0.24-1.94), pain (RR=0.22, 95%CI: 0.01-4.32).

Current evidence indicate that talc is super to bleomycin for patients with malignant pleural effusions in terms of improving treatment success and reducing recurrence rate, there is no significant difference between the two group with regard to case fatality rate, fever, pain, the results mentioned above still need to be confirmed by high quality, large sample, multicenter randomized controlled trial.