Review on Treatment of Pleural Metastasis and Malignant Pleural Effusion with Pressurized IntraThoracic Aerosol Chemotherapy (PITAC)

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.