Mastromarino Maria Giovanna, Aprile Vittorio, Elia Gianmarco, Bacchin Diana, Lenzini Alessandra, Korasidis Stylianos, Ambrogi Marcello Carlo, Ferrari Silvia Martina, Fallahi Poupak, Lucchi Marco
Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Roma, 56124 Pisa, Italy.
Methods Protoc. 2025 May 14;8(3):51. doi: 10.3390/mps8030051.
Pleural carcinomatosis (PC) and malignant pleural effusion (MPE) affect up to 20% of patients with non-small cell lung cancer (NSCLC) and are usually synonymous with poor prognosis. Pressurized Intra-Thoracic Aerosol Chemotherapy (PITAC) is a novel and promising technique to control MPE in PC-NSCLC. This pilot study aimed to assess the feasibility, safety, and efficacy of PITAC in terms of palliative pleurodesis and evaluate the local antineoplastic control by analyzing patient-derived primary cell cultures. From January to December 2023, seven patients underwent PITAC with tailored doses of cisplatin and doxorubicin. There were four males and three females, with a median age of 65 (IQR:19) years. No operating room contamination by aerosolized chemotherapeutics was observed. No intraoperative complications occurred, and 30-day mortality was nil. One patient developed a postoperative prolonged air leak. The median chest tube stay was 2 (IQR:2) days, and the median hospital stay was 4 (IQR:2) days. No systemic toxicity nor hypersensitivity to chemotherapeutics were observed. All patients developed effective pleurodesis in 30 days. Cell cultures obtained from biopsy of PC-NSCLC sampled before PITAC formed confluent and monolayer sheets of attached tumor cells, while after 30 min from PITAC, cultures exhibited a significant reduction in the cancer cells' growth. Effective pleurodesis was observed three and six months after surgery in all patients. PITAC is a safe and effective technique to control MPE recurrence and might revolutionize loco-regional therapy for PC-NSCLC. Further research should assess its oncological role.
胸膜癌转移（PC）和恶性胸腔积液（MPE）影响高达20%的非小细胞肺癌（NSCLC）患者，通常是预后不良的同义词。胸腔内加压气溶胶化疗（PITAC）是一种控制PC-NSCLC中MPE的新颖且有前景的技术。这项前瞻性研究旨在评估PITAC在姑息性胸膜固定术方面的可行性、安全性和有效性，并通过分析患者来源的原代细胞培养物来评估局部抗肿瘤控制效果。2023年1月至12月，7例患者接受了PITAC治疗，使用了量身定制剂量的顺铂和阿霉素。其中男性4例，女性3例，中位年龄65（四分位间距：19）岁。未观察到雾化化疗药物对手术室的污染。未发生术中并发症，30天死亡率为零。1例患者术后出现持续性气胸。胸管留置时间中位数为2（四分位间距：2）天，住院时间中位数为4（四分位间距：2）天。未观察到全身毒性或对化疗药物的超敏反应。所有患者在30天内均形成了有效的胸膜固定术。在PITAC前采集的PC-NSCLC活检组织的细胞培养物形成了附着肿瘤细胞的汇合单层片，而在PITAC后30分钟，培养物显示癌细胞生长显著减少。所有患者在术后3个月和6个月均观察到有效的胸膜固定术。PITAC是一种控制MPE复发的安全有效技术，可能会彻底改变PC-NSCLC的局部区域治疗。进一步的研究应评估其肿瘤学作用。
