Review on treatment of pleural metastasis and malignant pleural effusion with Pressurized IntraThoracic Aerosol Chemotherapy (PITAC)
Pleura and Peritoneum 2024 May 17 [Link]
Pernille Schjødt Hansen, Martin Graversen, Sönke Detlefsen, Michael Bau Mortensen
Abstract
Background: Malignant pleural effusion (MPE) is a common and debilitating condition seen in advanced cancer disease, and life-expectancy is short. Symptoms include pain and severe shortness of breath. Current first-line treatment options include pleural drainage using catheters as well as pleurodesis. However, these treatment modalities are often inefficient and patients need repeated procedures. Pressurized IntraThoracic Aerosol Chemotherapy (PITAC) is a minimally invasive procedure, where antineoplastic agents are nebulized under pressure into the pleural space.
Content: We present the preliminary safety, feasibility, and response assessment data for PITAC based on a comprehensive literature review.
Summary: Five retrospective studies reported data on 38 PITACs in 21 patients. Data were heterogeneous and incomplete on several important aspects such as procedure, safety, local effect and long-term outcomes. PITAC seems technically feasible with a low risk of complications and may provide some reduction in MPE in selected cases.
Outlook: PITAC seems feasible, but prospective phase I and II studies are needed to define safety, indications, and efficacy.