Introduction

Malignant pleural effusion (MPE) affects up to one-third of oncological patients and usually has a poor prognosis. PITAC is a novel and promising technique to control MPE.

Aims and objectives

The main aim of this pilot study was to assess safety, feasibility and efficacy of PITAC in controlling primary and secondary MPE; secondary, we evaluated the pleural effusion-free survival (PEFS).

Methods

Clinical and oncological data of patients with MPE who underwent video-assisted thoracoscopic surgery (VATS) were prospectively collected. Patients were divided in 2 groups according to the procedure: PITAC with tailored doses of cisplatin and doxorubicin vs talc poudrage. Propensity score-matching (PSM) analysis was performed to minimize potential confounding bias.

Results

From January to August 2022, 40 patients (16 M and 24 F) with a mean age of 69.4±10.5 years and pathological MPE underwent VATS pleurodesis. After PSM we selected 34 patients divided in 2 comparable groups (PITAC vs talc group). No intraoperative complications occurred in both groups. 30-days mortality was nil in both groups. PITAC was comparable to talc poudrage in term of chest-tube length (3.5±3.2 vs 2.4±1.1 days, p=0.18), post-operative complications (5.9% vs 0.0%, p=0.50) and hospital stay (6.0±5.4 vs 4.7±2.3 days, p=0.37). All patients developed an effective pleurodesis at 30-days. After a median follow-up of 5 months, the two groups had comparable PEFS (HR, 0.30; 95%CI, 0.05-1.75) with a 2-months PEFS as 88% and 94% for PITAC and talc group, respectively (p=0.16).

Conclusions

PITAC is a safe and effective technique to control MPE recurrence. Further investigations should also assess the oncological role.