Pressurized intrathoracic aerosol chemotherapy (PITAC): a new surgical technique for treatment of metastatic pleural effusion and pleural metastasis

Abstract: Pressurized intrathoracic aerosol chemotherapy (PITAC) is a new therapeutic option in patients with malignant pleural effusion (MPE) and/or pleural metastasis (PM) which could provide an effective pleurodesis combined to an anti-neoplastic effect. Among the tumors that cause MPE, lung cancer is the most common cause, followed by breast cancer, malignant mesothelioma, ovarian neoplasm and lymphoma. The procedure is indicated for patients with an Eastern Cooperative Oncology Group (ECOG) performance status ≤2, without extra-thoracic metastases and is performed in video-assisted thoracoscopy surgery (VATS); general anesthesia is required with a double-lumen endotracheal tube and the chemotherapy (solutions of cisplatin and doxorubicin) is nebulized using a special device in the pleural cavity. After the nebulization, the system is left in steady-state and after 30 minutes staff provides to removes the remaining aerosol using a closed surgical smoke evacuation system. Our initial experience is based on six procedures, which appeared to be safe and feasible with no recurrence of MPE (computed tomography scan). We don’t report intraoperative and postoperative complications (no systemic absorption of drug with normal creatinine levels). In this article, we described PITAC as a repeatable technique for controlling MPE recurrence. However, although this technique is promising for PM, further studies, in which patients are evaluated in the same way as those receiving pressurized intraperitoneal aerosol chemotherapy, are needed to assess its oncological benefits.