0
Correspondence |

Complications of Talc Poudrage in the United States FREE TO VIEW

Yossef Aelony, MD, FCCP
Author and Funding Information

From the Southern California Permanente Medical Group.

Correspondence to: Yossef Aelony, MD, FCCP, Southern California Permanente Medical Group, Kaiser-Permanente Lakeside Bldg, Medicine III, 25825 Vermont Ave S, Harbor City, CA 90710; e-mail: y.aelony@cox.net


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(2):477. doi:10.1378/chest.10-2267
Text Size: A A A
Published online

To the Editor:

A recent article in CHEST (June 2010) by Gonzalez et al1 on the complications of talc pleurodesis is important because it may be the largest report on the use of Sclerosol talc (Bryan Corporation; Woburn, Massachusetts), the only proprietary talc sanctioned by the US Food and Drug Administration (FDA). The article would have been enhanced if the authors had shared their 1- to 6-month success rates for pleurodesis, because Sclerosol may be more or less effective than other talcs. Conversations with Bryan Corporation representatives suggest that the current talc is different from the original one.

One of their goals (to define the incidence of lung injury from talc) cannot be met in this kind of retrospective study because a pathognomonic finding for talc lung injury has not been defined. Their estimate of a 2.8% incidence is subjective, which they acknowledge (referred to as “consensus” in their article). Radiographic findings may be seen after pleural drainage or thoracoscopy without talc insufflation.

Two articles were inappropriately referenced as showing complications of talc insufflation. Rehse et al2 found zero cases of respiratory failure after simple talc poudrage but several cases of ARDS when talc was applied following pleural abrasion, a procedure that disrupts blood vessels, allowing access of talc to the circulation. Dressler et al,3 in comparing bedside talc slurry per chest tube with video-assisted thoracic surgery/talc poudrage, inappropriately implicated talc insufflation in the complication rate. The patients who underwent video-assisted thoracic surgery had six complications of bronchopleural fistula, indicating that the patients had surgical procedures, not simple talc insufflation; bronchopleural fistula is not a complication of medical thoracoscopic talc insufflation.

There are many US Pharmacopeia talcs available in the United States. We reported 286 consecutive thoracoscopic talc poudrages using talc from Spectrum Chemical Co (Gardena, California), without any pulmonary infiltrates ascribed to talc when given in 5-g doses.4 Unfortunately, the FDA recently ruled arbitrarily that US Pharmacopeia talc must be sterilized under the supervision of a pharmacist, even though other thoracoscopic materials are sterilized by the hospital’s central supply. Many pharmacies are not equipped for the sterilization procedure. Our team switched to Sclerosol in 2004, which raised the talc cost per patient from 15 cents to $240. Our success rate of 90% at 1 year with the Spectrum talc5 dropped to 13/18 (72%) (Y. Aelony, MD, unpublished data, 2002, 2004), stressing the importance of the unknown success rate in the article by Gonzalez et al.1 I second Gonzalez’ call for the FDA to approve the European-graded (large-particle) talc because it has been shown prospectively not to cause ARDS in 558 cases,6 and it has a long-term effectiveness of about 90% in thousands of cases.

Gonzalez AV, Bezwada V, Beamis JF Jr, Villanueva AG. Lung injury following thoracoscopic talc insufflation: experience of a single North American center. Chest. 2010;1376:1375-1381. [CrossRef] [PubMed]
 
Rehse DH, Aye RW, Florence MG. Respiratory failure following talc pleurodesis. Am J Surg. 1999;1775:437-440. [CrossRef] [PubMed]
 
Dresler CM, Olak J, Herndon JE 2nd, et al; Cooperative Groups Cancer and Leukemia Group B Cooperative Groups Cancer and Leukemia Group B Eastern Cooperative Oncology Group Eastern Cooperative Oncology Group North Central Cooperative Oncology Group North Central Cooperative Oncology Group Radiation Therapy Oncology Group Radiation Therapy Oncology Group Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest. 2005;1273:909-915. [CrossRef] [PubMed]
 
Aelony Y. Non-association of adult respiratory distress syndrome (ARDS) with small particle talc poudrage [abstract]. Chest. 2002;1658:A35
 
Aelony Y, King R, Boutin C. Thoracoscopic talc poudrage for chronic pleural effusions. Ann Intern Med. 1991;11510:778-782. [PubMed]
 
Janssen JP, Collier G, Astoul P, et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet. 2007;3699572:1535-1539. [CrossRef] [PubMed]
 

Figures

Tables

References

Gonzalez AV, Bezwada V, Beamis JF Jr, Villanueva AG. Lung injury following thoracoscopic talc insufflation: experience of a single North American center. Chest. 2010;1376:1375-1381. [CrossRef] [PubMed]
 
Rehse DH, Aye RW, Florence MG. Respiratory failure following talc pleurodesis. Am J Surg. 1999;1775:437-440. [CrossRef] [PubMed]
 
Dresler CM, Olak J, Herndon JE 2nd, et al; Cooperative Groups Cancer and Leukemia Group B Cooperative Groups Cancer and Leukemia Group B Eastern Cooperative Oncology Group Eastern Cooperative Oncology Group North Central Cooperative Oncology Group North Central Cooperative Oncology Group Radiation Therapy Oncology Group Radiation Therapy Oncology Group Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest. 2005;1273:909-915. [CrossRef] [PubMed]
 
Aelony Y. Non-association of adult respiratory distress syndrome (ARDS) with small particle talc poudrage [abstract]. Chest. 2002;1658:A35
 
Aelony Y, King R, Boutin C. Thoracoscopic talc poudrage for chronic pleural effusions. Ann Intern Med. 1991;11510:778-782. [PubMed]
 
Janssen JP, Collier G, Astoul P, et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet. 2007;3699572:1535-1539. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543