Efficacy and safety of thoracoscopic photodynamic therapy combined with 5% ethanol–cisplatin intrapleural perfusion in the treatment of malignant pleural effusion in non-small cell lung cancer

Malignant pleural effusion (MPE) is a common and serious manifestation of advanced non-small cell lung cancer (NSCLC). This study aimed to retrospectively evaluate the efficacy and safety of thoracoscopic photodynamic therapy (PDT) combined with 5% ethanol-cisplatin intrapleural perfusion compared to cisplatin intrapleural perfusion or drainage alone. This retrospective study analyzed 122 NSCLC patients with MPE who had failed first-line chemotherapy. Patients were divided into three groups: PDT combined with 5% ethanol-cisplatin (PDT + E-Cis, n = 32), intrapleural cisplatin perfusion (IP-Cis, n = 39), and drainage alone control (Control, n = 51). All patients received systemic chemotherapy with docetaxel. Observation endpoints included overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and safety. At week 12, the ORR of the PDT + E-Cis group was 75.0%, significantly higher than that of the IP-Cis group (43.6%) and the Control group (17.6%) (All P < 0.05). Survival analysis showed that the median PFS of the PDT + E-Cis group (6.13 months) was significantly longer than that of the Control group (3.48 months, P = 0.005), but showed no statistical difference compared to the IP-Cis group (4.21 months, P = 0.229). The median OS (14.17 months) was significantly superior to that of the Control group (8.88 months, P < 0.001) and showed a trend towards prolongation compared to the IP-Cis group (11.23 months, P = 0.033). Regarding safety, the incidence of chest pain and fever in the PDT + E-Cis group was higher than in the Control group but similar to the IP-Cis group. Most adverse events were grade 1–2, with no treatment-related deaths or severe adverse events occurring. Thoracoscopic PDT combined with 5% ethanol-cisplatin intrapleural perfusion demonstrates favorable safety and efficacy. It can significantly improve the local control rate of MPE in NSCLC and shows clinical potential for prolonging patient survival.