Polyhematoporphyrin-mediated photodynamic therapy and decortication in palliation of malignant pleural mesothelioma: a clinical pilot study*1

Abstract

The aim of this study was to evaluate the additional effect of intraoperative photodynamic therapy (PDT) under hyperbaric oxygenation (HBO) when compared with decortication alone. From 1/1993 to 8/2002, palliation with decortication was done in 25 patients suffering from advanced malignant pleural mesothelioma. Fourteen patients received additional intraoperative PDT under HBO. The surgery and PDT/HBO was done 48 h after photosensitization with a polyhematoporphyrin, 2 mg/kg/BW using a diode laser delivering red light at 630 nm through a microlens. The light dose was calculated for 300 J with a distance of 1 cm from the tumor surface. At 6-month follow up local tumor control and survival showed a significant difference in both groups. Although the study only includes a small number of patients not allowing definite conclusions, it indicates that the additional PDT/HBO represents a safe and technically feasible approach in the palliative setting of advanced malignant mesothelioma of the pleura.

A systematic review of lung-sparing extirpative surgery for pleural mesothelioma

“…21 In some, particularly more recent series, PD is performed with radical intent. 8 We judge that resection of the diaphragm or pericardium was infrequently performed in early series because it is specifically mentioned if done 16,31,32 whereas it is included in the general operative description in more recent reports. 5,8,11,13 It appears that it was optional with a degree of selection for appropriateness but it is often unclear in how many patients these steps were taken ( Table 2).…”

The clinical impact of photodynamic therapy in thoracic surgery

“…Due to this fact, a new approach consisting of PDT under hyperbaric oxygenation (HBO) under 2 ATA (atmosphere absolutes) performed in a hyperbaric chamber was experimentally considered in order to achieve an enhancement of the effect of PDT. Several pilot studies investigating the therapeutic benefit of PDT under HBO in comparison to PDT under normo-baric conditions were carried out at our department and published in literature [6,7,16,[37][38][39].…”

“…Because of this lack of sufficient treatment options for MPM [10,11], it is a challenge to establish further novel adjunctive therapeutical approaches which may help to improve the poor prognosis of patients suffering from MPM. The efficiency of PDT as a supportive treatment option in case of MPM has been described and established in several clinical studies [12][13][14][15][16][17][18][19][20].…”

Intraoperative adjuncts for malignant pleural mesothelioma

“…A prospective phase II trial using EPP or PD followed by porfimer sodiummediated PDT occurring from 1991 to 1996 determined that PDT dose was an independent prognostic indicator of survival for involved patients (P<0.009) (35), while a phase I/II dose escalation study of intraoperative m-THPC-PDT following EPP in 2001 determined considerable toxicity associated with PDT and local control in only 50% of studied patients (36). A 2004 study then showed the safety and feasibility of polyhematoporphyrin-mediated PDT for fourteen patients with advanced MPM under hyperbaric oxygen with an improved median survival in the PDT group (P=0.0179) (37).…”