Influence of Particle Size on Extrapleural Talc Dissemination After Talc Slurry Pleurodesis

Ferrer, Jaume; Montés, Juan Francisco Jordán; Villarino, Maria Antonia; Light, Richard W.; García‐Valero, José

doi:10.1378/chest.122.3.1018

Cited by 115 publications

(78 citation statements)

References 18 publications

(21 reference statements)

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“…Among the factors related to the inflammatory response some, such as the size, composition of the talc particles and the injected dose, should be taken into consideration [7,11,16,17,20]. Our study supports the observation that early clinical manifestation, in particular acute respiratory failure, appears in the first 96 h following the procedure.…”

Section: Discussionsupporting

confidence: 86%

“…FERRER et al [16] suggest that the small particles may cross the pleural lymphatic stomas (6.2 mm in humans) reaching the lymphatic blood vessels before the systemic circulation and inducing a systemic and pulmonary inflammatory response. In our study, both sizes of talc particles were observed in the lungs, although with no significant difference between the groups ( fig.…”

Section: Pleural Disease Vf Rossi Et Almentioning

confidence: 99%

“…In this scenario, the smaller the particle the higher the chance of migration. In fact, countries where smaller talc particles are used, in general present a greater incidence of respiratory failure following pleurodesis [16]. However, contradictory to these facts, in the literature there is a necroscopic reference to a patient who died as a result of respiratory failure after undergoing pleurodesis, with no evidence of systemic migration of talc [12].…”

mentioning

confidence: 99%

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Acute inflammatory response secondary to intrapleural administration of two types of talc

Rossi

Vargas²,

Marchi³

et al. 2009

European Respiratory Journal

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Intrapleural instillation of talc has been used in the treatment of recurrent pleural effusions but can, in rare instances, result in respiratory failure. Side-effects seem to be related to composition, size and inflammatory power of talc particles. The aim of this study was to evaluate the inflammatory response to intrapleural injection of talc containing small particles (ST) or talc containing particles of mixed size (MT).100 rabbits received intrapleural talc, 50 with ST (median 6.41 mm) and 50 with MT (median 21.15 mm); the control group was composed of 35 rabbits. Cells, lactate dehydrogenase, Creactive protein (CRP), interleukin (IL)-8 and vascular endothelial growth factor were evaluated in serum and bronchoalveolar lavage at 6, 24, 48, 72 and 96 h.Lung histology and the presence of talc were also analysed. Statistics were performed using ANOVA and an unpaired t-test. Most of the parameters showed greater levels in the animals injected with talc than in the controls, suggesting a systemic and pulmonary response. Higher serum levels of CRP and IL-8 were observed in the animals injected with ST. Talc particles were observed in both lungs with no differences between groups. Lung cell infiltrate was more evident in the ST group.In conclusion, talc with larger particles should be the preferred choice in clinical practice in order to induce safer pleurodesis.

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Section: Discussionsupporting

confidence: 86%

Section: Pleural Disease Vf Rossi Et Almentioning

confidence: 99%

mentioning

confidence: 99%

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Acute inflammatory response secondary to intrapleural administration of two types of talc

Rossi

Vargas²,

Marchi³

et al. 2009

European Respiratory Journal

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“…Also, several reports 28,29 describe acute pulmonary distress of patients who received only 2 g of talc as a poudrage. Inconsistent incidence among reported series suggests a possible relationship to the size of talc particles 30 or to specific contaminants, both of which can vary among talc sources. 31 The etiology of acute respiratory complications is unclear.…”

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

507

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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“…Foreign materials such as talc, starch, cotton, and cellulose used as insoluble binding agents in oral tablets, are first pulverized, then dissolved in water and injected by intravenous drug users, and may be carried by the bloodstream until they lodge in the pulmonary capillary bed to cause NTPE (Farber et al, 1989;Ferrer et al, 2002;Low & Nicol, 2006;Pare et al, 1989). The advent of modern percutaneous interventional procedures has led to a rise in catheter or fragment related pulmonary embolism.…”

Section: Othersmentioning

confidence: 99%

Non-Thrombotic Pulmonary Embolism

Balasubramanian¹,

Aparnath²,

Mathur³

2012

Pulmonary Embolism

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Influence of Particle Size on Extrapleural Talc Dissemination After Talc Slurry Pleurodesis

Cited by 115 publications

References 18 publications

Acute inflammatory response secondary to intrapleural administration of two types of talc

Acute inflammatory response secondary to intrapleural administration of two types of talc

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

Non-Thrombotic Pulmonary Embolism

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