Medical Thoracoscopic Thermal Ablation Therapy For Metastatic Pleural Tumors With Malignant Effusion:an Clinical Study

Objective:This paper is to explore the clinical efficacy and safety of medical thoracoscopic thermal ablation therapy for metastatic pleural tumor with malignant effusion and conduct a comparative study on different thermal ablation methods.MethodsWe retrospectively analyzed clinical data of 152 patients diagnosed of metastatic pleural tumor with malignant effusion from May 2015 to March 2019 at Integrated Hospital of Traditional Chinese Medicine,Southern Medical University.All cases received standard systemic treatment following the NCCN guidelines,and were intrapleurally injected chemotherapy drug Cisplatin through chest tube.Among them,53 cases were in the indwelling pleural catheter group,and 99 cases underwent medical thoracoscopic exploration which was further divided into the non-ablation group(n=48)and thermal ablation group(n=51)according to whether thermal ablation was performed.The thermal ablation group included 26 cases receiving Argon Plasma Coagulation(APC)treatment and 25 cases receiving Laser Photoresection(LPR)treatment.The efficacy of pleural effusion control and patient survival time were compared among different groups,and the incidence of complications and the changes of vital signs were observed.Results:The effective rate of pleural effusion control in both the thermal ablation group(88.2%)and non-ablation group(77.1%)was significantly higher than that of indwelling pleural catheter group(56.6%)(P<0.001).The median overall survival(m OS)time of the thermal ablation group,non-ablation group,and indwelling pleural group was 14.5months,12.7months and 10.3months,respectively(P<0.001).Among the thermal ablation group,18 cases(69.2%)achieved complete response(CR)and 6 cases(23.1%)achieved partial response(PR)in patients receiving APC treatment,9 cases(36.0%)achieved CR and 12 cases(48.0%)achieved PR in patients receiving LPR treatment(P=0.023).The m OS time of the APC and LPR treatment group was 18.9months and 13.5months with marginal significant difference(P=0.051)while the median progress free survival time was 16.1months and 9.7months respectively(P=0.033).There was no significant difference in terms of the incidence of complications(such as fever : 13.7% vs 16.7%,chest pain : 21.6% vs 18.8%,intraoperative bleeding:7.8% vs 6.3%)and changes of vital signs(HR:90.9±14.9 vs88.4±11.7、R:19.5±2.8 vs 19.3±2.1、SO2%:95.9±2.4 vs 96.2±2.4、Map:91.7±2.2vs 91.2±2.9)between the thermal ablation group and the non-ablation group.ConclusionsMedical thoracoscopic thermal ablation therapy was effective and safe in the treatment of metastatic pleural tumor,which can improve the efficacy of malignant effusion and prolong the survival time.APC has advantages over LPR in thermal ablation which we recommend as a preferred choice in the clinical practice.