International Society for Minimally Invasive Cardiothoracic Surgery

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Pressurized Intra-thoracic Aerosol Chemotherapy (pitac): Preliminary Results In Malignant Pleural Effusion
Gianmarco Elia1, Maria Giovanna Mastromarino2, Fabrizia Calabro'1, Diana Bacchin2, Stylianos Korasidis2, Vittorio Aprile2, Marcello Carlo Ambrogi2, Marco Lucchi2
1Department of surgical, medical, molecular, and critical area pathology, University of Pisa - Division of Thoracic Surgery, Pisa, Italy, Pisa, Italy, 2Division of Thoracic Surgery Cardiac, Thoracic and Vascular Department University Hospital of Pisa - Italy, Pisa, Italy

BACKGROUND:Malignant pleural effusion (MPE) affect up to 15% of patients with cancer and it is burdened by a very poor prognosis. Pleurodesis is the standard palliative treatment, aiming to prevent MPE recurrence and reduce dyspnea. Pressurized Intra-Thoracic Aerosol Chemotherapy (PITAC) is a novel and promising therapeutic strategy which could provide an effective pleurodesis combined to an anti-neoplastic effect, by delivering into the thorax an high pressure aerosol of chemotherapeutic agents.The purpose of the present study was to evaluate the safety and efficacy of PITAC in terms of palliation in symptomatic patients with MPE. METHODS:From January 2022 to December 2023, twenty-five PITAC were performed at our center. By videothoracoscopy, under general anaesthesia, using a remote-control, cisplatin and doxorubicin at doses of 10.5 mg/m2 and 2.1 mg/m2, respectively, were consecutively aerosolized into the pleural cavity at 0.7 mL/s flow with a maximal upstream pressure of 220 Psi via a nebulizer. This closed system was left in steady-state for 30 minutes. PITAC efficacy was evaluated according to World Health Organization (WHO) Criteria. RESULTS:Mean operative time was 123 minutes (range 95-165), including perfusion and frozen section time. No operative room contamination by aerosolized chemotherapeutic drugs was observed. No intraoperative complications occurred and 30-days mortality was nil. No postoperative complications was observed in 24 patients (96%), while 1 patient (4%) developed postoperative prolonged air leak, requiring new chest-tube placement . Two patients underwent a second PITAC for MPE recurrence, after one year from the first procedure. Mean postoperative hospital stay was 3 days (range 2-15 ), while the average chest-tube length was 2 days (range 2-4). All patients developed an effective pleurodesis at 30-days. At 3- and 6-months after surgery an effective pleurodesis continued to be observed in the whole cohort, namely chest X-ray showed a complete response in 15 patients (60 %) and a partial response in 10 (40%) cases, according to WHO Criteria. CONCLUSIONS:PITAC is a safe and effective technique to control MPE recurrence. PITAC might represent a pioneering treatment in the field of loco-regional therapy for pleural carcinomatosis. Further investigations should also assess the oncological role.


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