The dynamics of selected local inflammatory markers to talc in the treatment of malignant pleural effusions

Abstract

Background. Malignant pleural effusions accumulate in the space between the visceral (inner) layer covering the lungs and the parietal (outer) layer covering the chest wall. Larger effusions compress the pulmonary parenchyma resulting in increasing dyspnoea. Treatment is always local and palliative. Among others, chemical pleurodesis using talc can be performed in selected patients. Talc is hydrated magnesium silicate (chemically H 2 Mg 3 (SiO 3 ) 4 ) and has been used for pleurodesis since 1935. Videothoracoscopic talc powder insufflation (talc poudrage) is the most effective.However, markers of inflammatory reactions to extraneous substances like talc are not fully understood. The aim of this study was to assess the course of local inflammatory changes in the pleural cavity after talc insufflation. Methods. The Department of Cardiac Surgery of the Faculty of Medicine and University Hospital in Hradec Kralove, treated 47 patients aged 65 on average; 29 males and 18 females with proven recurrent malignant pleural effusion of various aetiologies from January 2009 to December 2010. They were retrospectively divided into group A (40 patients) without recurring effusion, and group B (7 patients) with recurring effusion and the need for thoracentesis or chest drainage during the 9-month monitoring. Results. Major findings were made in soluble forms of cell receptors. Group B showed statistically higher levels of the anti-inflammatory form of sCD-163 receptor in pleural fluid before the talc poudrage. This showed limited ability to create an adequate inflammatory response to external stimuli. This group also showed lower levels of the inflammatory form of sTLR-2 receptor immediately after the talc insufflation. This revealed low local reactivity to external stimuli. The effect of the treatment was not influenced by morphologic tumour type. No statistically significant differences in postoperative complications were found. This confirmed the safety of both videothoracoscopy and treatment. Conclusions. There was no correlation between the type of malignant affection and the outcome of the chemical pleurodesis. Patients with relapsing effusion have higher values of concentration of anti-inflammatory sCD-163 in pleural fluid even before the application of talc, and lower levels of concentration of inflammatory sTLR-2 immediately after application of talc.

Combined surgical treatment of lung cancer and heart diseases

“…The pathophysiological base of both entities is common (5). The probability of simultaneous incidence of lung cancer and coronary artery disease in men is around 6.9 % (6).…”

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

“…The relative monocyte fraction decreased 2 h after talcage to start increasing again in 24 h. These findings are confirmed by other authors 40 . In our previous study, different levels of local soluble receptors, reflecting the local inflammatory activity in the pleural effusion, were found between the group of patients with successful and unsuccessful pleurodesis 41,42 . To our knowledge, no study has assessed the direct effect of pleural talcage on the dynamic of changes in cell immunity in the pleural space.…”

New biomarkers in the selection of patients for talcage of pleural cavity in the palliative therapy of malign pleural exudate

“…Following administration of talc, the measurable differences in overall inflammatory response appeared between the groups as early as after 36-48 h (ref. 19 ). Talc particules activate the mesothelium of both the visceral and parietal pleurae, resulting in production of a fibrinous exsudate which in turn induces chemical pleurodesis.…”