Rationale: Talc is very effective for pleurodesis, but there is concern about complications, especially acute respiratory distress syndrome. Objectives: It was the aim of this study to investigate if talc with a high concentration of small particles induces greater production of cytokines, and if pleural tumor burden has any influence on the local production and spillover of cytokines to the systemic circulation and eventual complications. Methods: We investigated 227 consecutive patients with malignant effusion submitted to talc pleurodesis. One hundred and three patients received ‘small-particle talc' (ST; containing about 50% particles <10 µm) and 124 received ‘large-particle talc' (with <20% particles <10 µm). Serial samples of both pleural fluid and blood were taken before and 3, 24, 48 and 72 h after thoracoscopy. Also, mesothelial cells were stimulated with both types of talc in vitro. Measurements and Results: Interleukin-8, tumor necrosis factor-α, vascular endothelial growth factor, basic fibroblast growth factor and thrombin-antithrombin complex were measured in all samples. Early death (<7 days after talc) occurred in 8 of 103 patients in the ST and in 1 of 124 in the ‘large-particle talc' group (p = 0.007). Patients who received ST had significantly higher proinflammatory cytokines in pleural fluid and serum after talc application, and also in supernatants of the in vitro study. Pleural tumor burden correlated positively with proinflammatory cytokines in serum, suggesting that advanced tumor states induce stronger systemic reactions after talc application. Conclusions: ST provokes a strong inflammatory reaction in both pleural space and serum, which is associated with a higher rate of early deaths observed in patients receiving it.

Rinaldo JE, Owens GR, Rogers RM: Adult respiratory distress syndrome following intrapleural instillation of talc. J Thorac Cardiovasc Surg 1983;85:523-526.
Bouchama A, Chastre J, Gaudichet A, Soler P, Gilbert C: Acute pneumonitis with bilateral pleural effusion after talc pleurodesis. Chest 1984;86:795-797.
Kennedy L, Rusch VW, Strange C, Ginsberg RJ, Sahn SA: Pleurodesis using talc slurry. Chest 1994;106:342-346.
Rehse HD, Aye WR, Florence GM: Respiratory failure following talc pleurodesis. Am J Surg 1999;177:437-440.
Campos JR, Werebe EC, Vargas FS, Jatene FB, Light RW: Respiratory failure due to insufflated talc. Lancet 1997;349:251-252.
Ferrer J, Montes JF, Villarino MA, Light RW, García-Valero J: Influence of particle size on extrapleural talc dissemination after talc slurry pleurodesis. Chest 2002;122:1018-1027.
Maskell NA, Lee YC, Gleeson FV, Hedley EL, Pengelly G, Davies RJO: Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med 2004;170:377-382.
Werebe EC, Pazetti R, Milanez de Campos JR, Fernandez PP, Capelozzi VL, Jatene FB, Vargas FS: Systemic distribution of talc after intrapleural administration in rats. Chest 1999;115:190-193.
Fraticelli A, Robaglia-Schlupp A, Riera H, Monjanel-Mouterde S, Cau P, Astoul P: Distribution of calibrated talc after intrapleural administration: an experimental study in rats. Chest 2002;122:1737-1741.
Janssen JP, Collier G, Astoul P, Tassi GF, Noppen M, Rodriguez-Panadero F, et al: Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet 2007;369:1535-1539.
Gill AJ, Mathur MN, Tattersall SF: Systematic response to talc pleurodesis. Am J Respir Crit Care Med 2004;169:1074-1075.
Genofre EH, Vargas FS, Acencio M, Antonangelo L, Texeira LR, Marchi E: Talc pleurodesis: evidence of systemic inflammatory response to small size talc particles. Respir Med 2009;103:91-97.
Rossi VF, Vargas FS, Marchi E, Acencio MM, Genofre EH, Capelozzi VL, Antonangelo L: Acute inflammatory response secondary to intrapleural administration of two types of talc. Eur Respir J 2010;35:396-401.
Rodriguez Panadero F: Medical thoracoscopy. Respiration 2008;76:363-372.
Sanchez-Armengol A, Rodriguez-Panadero F: Survival and talc pleurodesis in metastatic pleural carcinoma, revisited. Report of 125 cases. Chest 1993;104:1482-1485.
Antony VB, Loddenkemper R, Astoul P, Boutin C, Goldstraw P, Hott J, Rodriguez Panadero F, Sahn SA: Management of malignant pleural effusions. Eur Respir J 2001;18:402-419.
Nasreen N, Mohammed KA, Dowling PA, Ward MJ, Galffy G, Antony VB: Talc induces apoptosis in human malignant mesothelioma cells in vitro. Am J Respir Crit Care Med 2000;161:595-600.
Miller Q, Meschter C, Neumaster T, Pratt J, Moulton M, Downey D, Harre J: Comparison of pleurodesis by erythromycin, talc, doxycycline, and diazepam in a rabbit model. J Surg Educ 2007;64:41-45.
Froudarakis ME, Klimathianaki M, Pougounias M: Systemic inflammatory reaction after thoracoscopic talc poudrage. Chest 2006;129:356-361.
Psathakis K, Calderon-Osuna E, Romero-Romero B, et al: The neutrophilic and fibrinolytic response to talc can predict the outcome of pleurodesis. Eur Respir J 2006;27:817-821.
Rodriguez-Panadero F, Montes-Worboys A: Mechanisms of pleurodesis. Respiration 2012;83:91-98.
Montes-Worboys A, Rodriguez-Portal JA, Arellano-Orden E, Digón-Pereiras J, Rodriguez-Panadero F: Interleukin-8 activates coagulation and correlates with survival after talc pleurodesis. Eur Respir J 2010;35:160-166.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.