Thoracoscopic Talc Poudrage in Malignant Pleural Effusions

Aelony, Yossef; King, Randal Robert; Boutin, C

doi:10.1378/chest.113.4.1007

Cited by 76 publications

(35 citation statements)

References 11 publications

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“…However, this is not absolute because effective pleurodesis can be achieved using talc by thoracoscopy despite the findings of low pleural fluid pH [23]. In conclusion, the present findings indicate that the acute inflammatory process in talc pleurodesis may have the active contribution of the mesothelial cells.…”

Section: Discussionmentioning

confidence: 54%

Evidence that mesothelial cells regulate the acute inflammatory response in talc pleurodesis

Marchi

Vargas²,

Acencio³

et al. 2006

Eur Respir J

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Intrapleural instillation of talc is used to produce pleurodesis in cases of recurrent malignant pleural effusions. The mechanisms by which pleurodesis is produced remain unknown but may involve either injury or activation of the mesothelium. The aim of the current study was to assess the inflammatory response of pleural mesothelial cells to talc in an experimental model in rabbits.A group of 10 rabbits were injected intrapleurally with talc (200 mg?kg -1 ) and undiluted pleural fluid was collected after 6, 24 or 48 h for measurement of interleukin (IL)-8, vascular endothelial growth factor (VEGF) and transforming growth factor (TGF)-b1. Samples of pleura were studied to assess the inflammatory infiltrate and mesothelial cell viability.The pleural fluid IL-8 concentration peaked at 6 h, whereas VEGF and TGF-b1 concentrations increased steadily over 48 h. Immunohistochemistry for cytokeratin showed a preserved layer of mesothelial cells despite the intense inflammatory pleural reaction.In conclusion, it is proposed that the mesothelial cell, although injured by the talc, may actively mediate the primary inflammatory pleural response in talc-induced pleurodesis.

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Section: Discussionmentioning

confidence: 54%

Evidence that mesothelial cells regulate the acute inflammatory response in talc pleurodesis

Marchi

Vargas²,

Acencio³

et al. 2006

Eur Respir J

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“…35,36 However, the predictive utility of pleural fluid pH is questioned by other authors. 37 Heffner and colleagues reported that pH has only "modest" value as a predictor of pleurodesis failure 38 or survival, 39 based on a meta-analysis that included 231 patients treated with thoracoscopic talc. Clinicians should acknowledge a small but currently unpredictable risk of severe respiratory complications including death.…”

Section: Discussionmentioning

confidence: 99%

Phase III Intergroup Study of Talc Poudrage vs Talc Slurry Sclerosis for Malignant Pleural Effusion

Dresler

Olak

Herndon³

et al. 2005

Chest

518

376

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Study objective-To demonstrate the efficacy, safety, and appropriate mode of instillation of talc for sclerosis in treatment of malignant pleural effusions (MPEs).Design-A prospective, randomized trial was designed to compare thoracoscopy with talc insufflation (TTI) to thoracostomy and talc slurry (TS) for patients with documented MPE.Measurements-The primary end point was 30-day freedom from radiographic MPE recurrence among surviving patients whose lungs initially re-expanded > 90%. Morbidity, mortality, and quality of life were also assessed.Results-Of 501 patients registered, those eligible were randomized to TTI (n = 242) or TS (n = 240). Patient demographics and primary malignancies were similar between study arms. Overall, there was no difference between study arms in the percentage of patients with successful 30-day outcomes (TTI, 78%; TS, 71%). However, the subgroup of patients with primary lung or breast cancer had higher success with TTI than with TS (82% vs 67%). Common morbidity included fever, dyspnea, and pain. Treatment-related mortality occurred in nine TTI patients and seven TS patients. Respiratory complications were more common following TTI than TS (14% vs 6%).Correspondence to: Carolyn Dresler, MD, MPA, Head, Tobacco Unit, International Agency for Research on Cancer, Lyon, France; Carolyn_dresler@ksg03.harvard.edu. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptRespiratory failure was observed in 4% of TS patients and 8% of TTI patients, accounting for five toxic deaths and six toxic deaths, respectively. Quality-of-life measurement demonstrated less fatigue with TTI than TS. Patient ratings of comfort and safety were also higher for TTI, but there were no differences on perceived value or convenience of the procedures. Since that time, a significant number of single institution reports have been published, primarily using thorascopically insufflated talc. However, a growing number of authors have advocated talc slurry via a percutaneously placed chest tube as a simpler and equally effective method for control of MPE with minimal short-term morbidity. However, several reports 10,11 of serious respiratory complications with talc have also been published. Conclusions-BothThe objectives of the current trial Cooperative Groups Cancer and Leukemia Group B (CALGB) 9334 compare tube thoracostomy with talc slurry (TS) to surgical thoracoscopy with talc insufflation (TTI), and assesses their efficacy at 30 days, in addition to the safety and associated quality of life in a randomized multicenter trial. Portions of this work have been presented in abstract form. 12 Materials and MethodsThis was an intergroup cooperative trial led by the CALGB and monitored semiannually by its Data and Safety Monitoring Board, with participation by the Radiation Therapy Oncology Group, the Eastern Cooperative Oncology Group (ECOG), and the North Central Cooperative Oncology Group, encompassing both private and teaching hospitals. Credentialing of participating surgeon...

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“…A trapped lung can be suggested by a failure of lung re-expansion after thoracentesis, a decrease of intrapleural pressure ,-20 cmH 2 O after fluid removal [71], and a negative pleural pressure of 19 cmH 2 O when removing 500 mL of fluid [72]. A very low pleural pH (,7.20) is frequently associated with the presence of trapped lung [60], but a successful pleurodesis can sometimes be achieved in these patients [73].…”

Section: Therapeutic Thoracentesismentioning

confidence: 99%

Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion

Rodríguez-Panadero

Janssen²,

Astoul³

2006

Eur Respir J

154

111

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Thoracoscopic Talc Poudrage in Malignant Pleural Effusions

Cited by 76 publications

References 11 publications

Evidence that mesothelial cells regulate the acute inflammatory response in talc pleurodesis

Evidence that mesothelial cells regulate the acute inflammatory response in talc pleurodesis

Phase III Intergroup Study of Talc Poudrage vs Talc Slurry Sclerosis for Malignant Pleural Effusion

Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion

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