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. 2020 Jan 14;11(6):1606-1613.
doi: 10.7150/jca.40004. eCollection 2020.

Pleurodesis and Immunotherapy in NSCLC; Medical Thoracoscopy or VATS?

Paul Zarogoulidis  1 , Haidong Huang  2 , Meng Yang  2 , Jun Zhou  3 , Yang Jiao  2 , Qin Wang  2 , Dimitris Petridis  4 , Konstantinos Sapalidis  1 , Chrysanthi Sardeli  5 , Parthenopi Konsta  1 , Charilaos Koulouris  1 , Nikolaos Michalopoulos  1 , Dimitrios Giannakidis  1 , Nikolaos Barbetakis  6 , Athanasios Katsaounis  1 , Wolfgang Hohenforst-Schmidt  7 , Aikaterini Amaniti  8 , Savvas Petanidis  9 , Kosmas Tsakiridis  10 , Nikolaos Courcoutsakis  11 , Alexandru Marian Goganau  12 , Anastasios Vagionas  13 , Konstantinos Romanidis  14 , Panagoula Oikonomou  14 , Michael Karanikas  15 , Iason Nikolaos Katsios  1 , Isaak Kesisoglou  1 , Christoforos Kosmidis  1
Affiliations

Pleurodesis and Immunotherapy in NSCLC; Medical Thoracoscopy or VATS?

Paul Zarogoulidis et al. J Cancer. .

Abstract

Introduction: Immunotherapy is a treatment option for non-small cell lung cancer advanced disease. However; immunotherapy in several patients induces orogonitis and effusion in different cavities. It is up to the treating physician to understand whether there is effusion due to adverse effect or disease progression. Pleurodesis in both cases might be a solution for recurrent pleura effusion. Patients and Methods: Three hundred and thirty seven non-small cell lung cancer patients with adenocarcinoma and pleura effusion during first line immunotherapy treatment underwent medical thoracoscopy or Video assisted thoracic surgery (VATS) for pleurodesis with talk poudrage. Uniportal medical thoracoscopy was performed under general with dual channel endotracheal tube in one hundred and eleven patients. Video assisted thoracic surgery was performed in one hundred and eighty seven patients and conversion from medical to VATS procedure was done to thirty nine patients. All patients had stage IV disease with pleura involvement and were under first line pembrolizumab treatment with 200mg (PD-L1 ≥ 50%). Results: The quantitative parameters of the study (expression, PY and cycle) were converted to an ordinal scale to facilitate the performance of statistical analysis. All parameters were examined as dependent against the parameter technique acting as independent to detect potential relationships. The results of multi Y versus X relationship revealed no statistically significant effect (p>0.05) of the three levels of technique against any response considered. Thus we can infer, quite safely, that the innovative operation (level 0) does not differ from the other two conventional methods (levels 2 and 3) through all parameters entered in the model. There was no significant difference between the different pleurodesis techniques. Discussion: Immunotherapy is known to induce in a number of patients pleura effusion and pericarditis. However; pleurodesis is efficient when the appropriate method is performed to every patient. Careful assessment in a case by case manner has to be performed for each patient before any procedure is performed.

Keywords: Medical Thoracoscopy; NSCLC; Pleurodesis; VATS.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Aerosol talk poudrage
Figure 2
Figure 2
Left figure, medical thoracoscopy tools usually used by pulmonary physicians, right; tools usually used by thoracic surgeons
Figure 3
Figure 3
Left; Heimlich valve, right; Redon draining system
Figure 4
Figure 4
Left; simple water draining system for air and fluids of thoracic cavity, right; automatic draining system for air and fluids of thoracic cavity
See this image and copyright information in PMC

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    Zarogoulidis P, Petridis D, Sapalidis K, Tsakiridis K, Baka S, Vagionas A, Hohenforst-Schmidt W, Freitag L, Huang H, Bai C, Drougas D, Theofilatou V, Romanidis K, Perdikouri EI, Petanidis S, Zaric B, Kovacevic T, Stojsic V, Sarcev T, Bursac D, Kukic B, Perin B, Courcoutsakis N, Athanasiou E, Hatzibougias D, Drevelegas K, Boukovinas I, Kosmidou M, Kosmidis C. Zarogoulidis P, et al. J Cancer. 2020 Sep 14;11(21):6454-6459. doi: 10.7150/jca.48691. eCollection 2020. J Cancer. 2020. PMID: 33033529 Free PMC article.

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