2011 Jun - Clinical efficacy and safety of chemical pleurodesis with talc slurry: comparison between two talc preparations in two public hospitals in Hong Kong
Dr Ka-Yan Wai
Department of Medicine, Kwong Wah Hospital
Background:
Talc pleurodesis is a common procedure used in malignant pleural effusion and recurrent/ secondary pneumothorax. Recent studies suggested that the systemic complications of talc pleurodesis including fever, desaturation and ARDS are related to the use of small particle size talc. In Hong Kong, talc preparations are not standardized. Many hospitals are using mixed particle size talc which include significant fraction of small particle size talc. Kwong Wah Hospital (KWH) and Tuberculosis and Chest Unit, Wong Tai Sin Hospital (TBCU, WTSH) have changed the talc slurry preparation from mixed particle size talc to Steritalc© (a graded talc preparation of larger mean particle size with small particle size portion removed) for chemical pleurodesis since Jan 2010 because of the latest evidences .
Objective
To study if there is any improvement in the safety profile and review the clinical efficacy of chemical pleurodesis with talc slurry by using Steritalc in two local hospitals (KWH and TBCU, WTSH).
Study Design and Method
It was a retrospective cohort study. Patients who received chemical pleurodesis with talc slurry in KWH and TBCU, WTSH from 1st January 2007 to 28th February 2011 were included. Patients were divided into 2 groups according to the types of talc they received: Mixed particle size talc (MT) from 1st January 2007 to 31st December 2009 and Steritalc(ST) from 1st January 2010 to 28th February 2011. Patients’ clinical data including demographic characteristics, co-morbidities and concomitant medication, indication of pleurodesis, methodology of pleurodesis including dosage and type of talc used were recorded. The difference of outcome measurements like the efficacy of pleurodesis and procedure-related complications were compared between the 2 groups.
Results
For the safety profile, there was no serious complication in the ST group. No patient developed ARDS in the ST group while there were 3 cases of ARDS (3.4%) in the MT group. Significantly less patients developed fever within 24 hours of pleurodesis in ST group (30.7% in MT group and 8.7% in ST group, p = 0.035). Also, fewer patients developed significant desaturation in the ST group. Before pleurodesis, the mean SaO2 was similar: 96.59 (1.86) % in MT group versus 97.00 (1.68) % in ST group, p = 0.341. After pleurodesis, the mean SaO2 was significantly better in the ST group: 94.21 (3.51) % in MT group versus 96.39 (1.56) % in ST group, p < 0.001. Median decrease of SaO2 after pleurodesis was less in the ST group: -2.4% (IQR -5.0% - 0.0%) in MT group versus 0.0% (IQR -1.0-0.0) in ST, p = 0.04.
The efficacy of ST for pleurodesis was comparable to MT. Immediate recurrence rate for pneumothorax was 19.6% by MT and 7.7% by ST, p = 0.432; 30-day recurrence rate for pneumothorax was 28.3% by MT and 7.7% by ST, p = 0.159; 30-day recurrence rate for malignant pleural effusion was 11.9% by MT and 10.0% by ST, p = 1.000.
Conclusion
This study showed that Steritalc, a large particle size talc preparation with fraction of small size particles removed, had a superior safety profile than mixed particle size talc. The efficacy was comparable between the two talc preparations. Steritalc should be the talc slurry preparation of choice for chemical pleurodesis.
