Predictive value of systemic and local inflammation parameters in talc pleurodesis assessment

Abstract

Background. One option for the palliative treatment of recurrent malignant pleural effusion is powdered talc using thoracoscopy. This paper presents the results of selected systemic and local manifestations of the talc-induced inflammatory reaction using a videothoracoscope. Method. A total of 114 patients with repeated malignant pleural effusion were treated at the Cardiac Surgery Clinic in Hradec Kralove from January 2010 to December 2012. Those with a life expectancy more than ≥ 3 months were eligible for talcage surgery. The group was retrospectively divided according to treatment results into Group A (N 1 = 98 -successful) and Group B (N 2 = 16 -relapsing). The pleural effusion was quantified using ultrasound over 1 year at 3-month intervals. Systemic changes due to the inflammatory reaction (body temperature, serum leukocyte and CRP levels) were evaluated. Local indicators of inflammation included changes in the leukocyte cell population in the effusion and changes in the pleural CRP levels. The dynamics of local expression of membrane receptors TLR-2 and CD-64 on granulocyte and monocyte cell populations in the pleural effusion were also evaluated. Results. The reaction after talcage, included a significant increase in axillary temperature and leukocyte count, 12 h after the procedure. The dynamics were different in the two groups. The dynamics of local inflammatory changes were an early increase in the pleural CRP levels in both groups. The time interval of local inflammatory development and duration was related to the treatment efficacy and showed a significant rise 2 h after talcage in Group A. In Group B the local inflammatory reaction was slower and the rise was only observed 24 h after talc application. A decrease in lymphocyte count and an increase in granulocyte count 2 h after talcage were found. After an initial drop in monocyte level, a rise occurred within 24 h after talcage. Changes in the expression of TLR-2 and CD-64 receptors in relation to their cell carriers were observed depending on time after talcage. Conclusion. The differences in the serum and pleural effusion CRP levels suggest that the surgical stress manifests itself locally in the pleural space with a lower intensity and time delay. The TLR-2 and CD-64 receptors exhibit different behaviour depending on the type of cell membrane where they are found. The inverse relation between the granulocyte increase and TLR-2 receptor decrease in the membrane immediately after talcage is a new finding. The dynamics of TLR-2 expression on the monocytes demonstrates a direct proportion between the increasing expression of the TLR-2 receptor and increasing percent fraction of the cell carrier.

Combined surgical treatment of lung cancer and heart diseases

“…The use of ECC may negatively infl uence many parameters of the immune system including leukocyte chemotaxis and cellmediated immunity, particularly T-lymphocytes (16). The use of…”

“…The psychological aspect of the earlier enabled tumor resection. The negative impact of the ECC on the immune system, which can enhance tumor proliferation, is eliminated in case of simultaneous procedures (16,17). A certain benefi t of one-stage procedure performed via a median sternotomy is the ability to perform bilateral mediastinal lymphadenectomy, which has an important prognostic value.…”

Predictors of outcome of pleurodesis in patients with malignant pleural effusion: a systematic review and meta-analysis

“…Psathakis et al [22] reported that pleural fluid neutrophils rose more profoundly after talc poudrage in the successful pleurodesis group in comparison to the failure group. The study by Habal et al [36] found that more pronounced increases in serum white cell count, and pleural fluid and serum CRP were seen in the success group in comparison to the failure group.…”

“…Three studies [22,24,36] examined the behaviour of blood and pleural fluid inflammatory markers in relation to pleurodesis outcome. Bilgin et al [24] found that erythrocyte sedimentation rate and blood C-reactive protein (CRP) values were increased in the postoperative period in patients with successful VATS pleurodesis but not in the failure group.…”

ERS/EACTS statement on the management of malignant pleural effusions

“…Small-particle talc was associated with higher inflammatory cytokine responses in one small non-randomised comparative study [37]. Interestingly, higher inflammatory responses were seen in patients following talc poudrage with successful pleurodesis compared with non-successful pleurodesis in a case series [38]. Similarly, higher fibrinolytic activity in pleural fluid has been associated with pleurodesis failure [39].…”