J Cancer 2020; 11(6):1606-1613. doi:10.7150/jca.40004

Research Paper

Pleurodesis and Immunotherapy in NSCLC; Medical Thoracoscopy or VATS?

Paul Zarogoulidis1#✉, Haidong Huang2✉, Meng Yang2#, Jun Zhou3#, Yang Jiao2#, Qin Wang2#, Dimitris Petridis4, Konstantinos Sapalidis1, Chrysanthi Sardeli5, Parthenopi Konsta1, Charilaos Koulouris1, Nikolaos Michalopoulos1, Dimitrios Giannakidis1, Nikolaos Barbetakis7, Athanasios Katsaounis1, Wolfgang Hohenforst-Schmidt8, Aikaterini Amaniti9, Savvas Petanidis10, Kosmas Tsakiridis11, Nikolaos Courcoutsakis12, Alexandru Marian Goganau13, Anastasios Vagionas14, Konstantinos Romanidis15, Panagoula Oikonomou15, Michael Karanikas16, Iason Nikolaos Katsios1, Isaak Kesisoglou1, Christoforos Kosmidis1

1. 3rd Department of Surgery, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
2. Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, P. R. China.
3. Department of Respiratory, Changzhou 1st People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, P.R. China.
4. Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece.
5. Department of Pharmacology & Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
6. Intensive Care Unit, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
7. Thoracic Surgery Department, “Theageneio” Cancer Hospital, Thessaloniki, Greece
8. Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, “Hof” Clinics, University of Erlangen, Hof, Germany
9. Anesthisiology Department, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
10. Department of Pulmonology, I.M. Sechenov First Moscow State Medical University, Moscow, 119992, Russian Federation.
11. Thoracic Surgery Department, Interbalkan ``European`` Medical Center, Thessaloniki, Greece
12. Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
13. General Surgery Clinic 1, University of Medicine and Pharmacy of Craiova, Craiova County Emergency Hospital, Craiova, Romania
14. Oncology Department, General Hospital of Kavala, Kavala, Greece
15. Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
16. Department of Surgery, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
#Paul Zarogoulidis, Meng Yang, Jun Zhou, Yang Jiao, Qin Wang contributed equally to this work.

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Citation:
Zarogoulidis P, Huang H, Yang M, Zhou J, Jiao Y, Wang Q, Petridis D, Sapalidis K, Sardeli C, Konsta P, Koulouris C, Michalopoulos N, Giannakidis D, Barbetakis N, Katsaounis A, Hohenforst-Schmidt W, Amaniti A, Petanidis S, Tsakiridis K, Courcoutsakis N, Goganau AM, Vagionas A, Romanidis K, Oikonomou P, Karanikas M, Katsios IN, Kesisoglou I, Kosmidis C. Pleurodesis and Immunotherapy in NSCLC; Medical Thoracoscopy or VATS?. J Cancer 2020; 11(6):1606-1613. doi:10.7150/jca.40004. Available from https://www.jcancer.org/v11p1606.htm

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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, Pleurodesis, NSCLC, VATS