title: Small particle-size talc is associated with poor outcome and increased inflammation in thoracoscopic pleurodesis.
abstract: BACKGROUND
  Talc is very effective for pleurodesis, but there is concern about complications, especially acute respiratory distress syndrome.
  
  
  OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Instituto de Biomedicina de Sevilla, Sevilla, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Arellano-Orden
authors.forename: Auxiliadora
authors.initials: A
authors.lastname: Romero-Falcon
authors.forename: José Martin
authors.initials: JM
authors.lastname: Juan
authors.forename: Manuel
authors.initials: M
authors.lastname: Ocaña Jurado
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodriguez-Panadero
authors.forename: Ana
authors.initials: A
authors.lastname: Montes-Worboys
mesh_terms: D015415:Biomarkers / Q000097:blood; D001779:Blood Coagulation Factors / Q000378:metabolism; D002478:Cells, Cultured; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood; D008171:Lung Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010316:Particle Size; D016066:Pleural Effusion, Malignant / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D010997:Pleural Neoplasms / Q000473:pathology; D018700:Pleurodesis / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013627:Talc / Q000009:adverse effects* / Q000737:chemistry; D013906:Thoracoscopy; D047368:Tumor Burden
chemical_list: D015415:Biomarkers; D001779:Blood Coagulation Factors; D016207:Cytokines; D036341:Intercellular Signaling Peptides and Proteins; D013627:Talc