330 patients with malignant pleural effusion, mean age 68 years
Follow-up
90 days
Primary endpoint
Pleurodesis failure at 90 days
Result
Pleurodesis failed in 36 of 161 (22%) after poudrage versus 38 of 159 (24%) after slurry — adjusted odds ratio 0.91 (95% CI 0.54 to 1.55, p=0.74), difference -1.8% (-10.7% to 7.2%). None of the 24 prespecified secondary outcomes differed significantly.
Secondary endpoints
24 prespecified secondary outcomes including symptoms, quality of life and survival
Among patients with malignant pleural effusion, thoracoscopic talc poudrage, compared with talc slurry delivered via chest tube, resulted in no significant difference in the rate of pleurodesis failure at 90 days. However, the study may have been underpowered to detect small but potentially important differences.
The trial authors, in the published abstract
How it has aged
A clean negative result with a practical consequence: if the two work equally, there is no reason to take a patient to thoracoscopy for pleurodesis alone. Combined with AMPLE, the modern question is catheter versus slurry, not which way to insufflate talc.
Publications
Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate Among Patients With Malignant Pleural Effusions: A Randomized Clinical Trial
Bhatnagar R, Piotrowska HEG, Laskawiec-Szkonter M, et al. Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate Among Patients With Malignant Pleural Effusions: A Randomized Clinical Trial. JAMA 2020 Jan 7;323(1):60-69.
No difference in pleurodesis failure at 90 days
No difference across any of 24 prespecified secondary outcomes