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Evaluating the efficacy of thoracoscopy and talc poudrage versus pleurodesis using talc slurry (TAPPS trial): protocol of an open-label randomised controlled trial
  1. Rahul Bhatnagar1,2,
  2. Magda Laskawiec-Szkonter3,
  3. Hania E G Piotrowska3,
  4. Brennan C Kahan4,
  5. Clare E Hooper5,
  6. Helen E Davies6,
  7. John E Harvey1,2,
  8. Robert F Miller7,8,
  9. Najib M Rahman3,9,
  10. Nick A Maskell1,2
  1. 1Respiratory Research Unit, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
  2. 2Academic Respiratory Unit, University of Bristol, Bristol, UK
  3. 3Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
  4. 4Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
  5. 5Respiratory Department, Worcestershire Royal Hospital, Worcester, UK
  6. 6Cardiff and Vale University Health Board, Cardiff, Wales, UK
  7. 7Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, London, UK
  8. 8Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
  9. 9Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
  1. Correspondence to Dr Nick A Maskell; Nick.Maskell{at}


Introduction The management of recurrent malignant pleural effusions (MPE) can be challenging. Various options are available, with the most efficacious and widely used being talc pleurodesis. Talc can either be applied via a chest drain in the form of slurry, or at medical thoracoscopy using poudrage. Current evidence regarding which method is most effective is conflicting and often methodologically flawed. The TAPPS trial is a suitably powered, multicentre, open-label, randomised controlled trial designed to compare the pleurodesis success rate of medical thoracoscopy and talc poudrage with chest drain insertion and talc slurry.

Methods and analysis 330 patients with a confirmed MPE requiring intervention will be recruited from UK hospitals. Patients will be randomised (1:1) to undergo either small bore (<14 Fr) Seldinger chest drain insertion followed by instillation of sterile talc (4 g), or to undergo medical thoracoscopy and simultaneous poudrage (4 g). The allocated procedure will be performed as an inpatient within 3 days of randomisation taking place. Following discharge, patients will be followed up at regular intervals for 6 months. The primary outcome measure is pleurodesis failure rates at 3 months. Pleurodesis failure is defined as the need for further pleural intervention for fluid management on the side of the trial intervention.

Ethics and dissemination The trial has received ethical approval from the National Research Ethics Service Committee North West—Preston (12/NW/0467). There is a trial steering committee which includes independent members and a patient and public representative. The trial results will be published in a peer-reviewed journal and presented at international conferences, as well as being disseminated via local and national charities and patient groups. All participants who wish to know the study results will also be contacted directly on their publication.

Trial registration number ISRCTN47845793.

  • Pleurodesis
  • Malignant pleural effusion
  • Randomised controlled trial
  • Talc

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