Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study.
BACKGROUND
Talc is the most effective chemical pleurodesis agent for patients with malignant pleural effusion. However, concerns have arisen about the safety of intrapleural application of talc, after reports of development of acute respiratory distress syndrome in 1-9% of treated patients. Our aim was to establish whether use of large-particle-size talc is safe in patients with malignant pleural effusion.


METHODS
We did a multicentre, open-label, prospective cohort study of 558 patients with malignant pleural effusion who underwent thoracoscopy and talc poudrage with 4 g of calibrated French large-particle talc in 13 European hospitals, and one in South Africa. The primary endpoint was the occurrence of acute respiratory distress syndrome after talc pleurodesis.


RESULTS
No patients developed acute respiratory distress syndrome (frequency 0%, one-sided 95% CI 0-0.54%). 11 (2%) patients died within 30 days. Additionally, seven patients had non-fatal post-thoracoscopy complications (1.2%), including one case of respiratory failure due to unexplained bilateral pneumothorax.


CONCLUSIONS
Use of large-particle talc for pleurodesis in malignant pleural effusion is safe, and not associated with the development of acute respiratory distress syndrome.
Janssen
Julius P
JP
Canisius Wilhelmina Hospital, Nijmegen, Netherlands. Electronic address: j.janssen@cwz.nl.
Collier
Gareth
G
Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
Astoul
Phillippe
P
Hôpital Sainte-Marguerite, Marseille, France.
Tassi
Gian Franco
GF
Spedali Civili, Brescia, Italy.
Noppen
Marc
M
University Hospital UZ Brussels, Brussels, Belgium.
Rodriguez-Panadero
Francisco
F
Hospital Universitario Virgen del Rocio Sevilla, Seville, Spain.
Loddenkemper
Robert
R
Lungenklinik Heckeshorn, Berlin, Germany.
Herth
Felix Jf
FJ
Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
Gasparini
Stefano
S
Azienda Ospedali Riuniti, Ancona, Italy.
Marquette
Charles H
CH
Centre Hospitalier Régional Universitaire Lille, Lille, France.
Becke
Birgit
B
Johanniter-Krankenhaus, Treuenbrietzen, Germany.
Froudarakis
Marios E
ME
University Hospital of Heraklion, Heraklion, Crete, Greece.
Driesen
Peter
P
St. Elisabeth Ziekenhuis, Turnhout, Belgium.
Bolliger
Chris T
CT
Tygerberg Academic Hospital, Cape Town, South Africa.
Tschopp
Jean-Marie
JM
Centre Valaisan de Pneumologie, Montana, Switzerland.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010316:Particle Size; D016066:Pleural Effusion, Malignant / Q000209:etiology / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012449:Safety; D013627:Talc / Q000009:adverse effects / Q000627:therapeutic use*; D013906:Thoracoscopy; D016896:Treatment Outcome
D013627:Talc