Radical Pleurectomy and Intraoperative Photodynamic Therapy for Malignant Pleural Mesothelioma

Quoted from http://ats.ctsnetjournals.org/cgi/content/abstract/93/5/1658?maxtoshow=&HITS=10&hits=6&RESULTFORMAT=&andorexacttitleabs=and&fulltext=mesothelioma&andorexactfulltext=and&searchid=1&usestrictdates=yes&resourcetype=HWCIT&ct

Radical Pleurectomy and Intraoperative Photodynamic Therapy for Malignant Pleural Mesothelioma

Joseph S. Friedberg, MDa,*, Melissa J. Culligan, BSNa, Rosemarie Mick, MSc, James Stevenson, MDe, Stephen M. Hahn, MDb, Daniel Sterman, MDd, Salman Punekar, MDb, Eli Glatstein, MDb, Keith Cengel, MD, PhDb

a Division of Thoracic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
b Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
c Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
d Division of Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
e Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania

Accepted for publication February 6, 2012.

* Address correspondence to Dr Friedberg, Penn-Presbyterian Medical Center, 51 N 39th St, Wright-Saunders Building, Ste 250, Philadelphia, PA 19104 (Email: joseph.friedberg@uphs.upenn.edu ).

Presented at the Forty-seventh Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2011.

Background: Radical pleurectomy (RP) for mesothelioma is often considered either technically unfeasible or an operation limited to patients who would not tolerate a pneumonectomy. The purpose of this study was to review our experience using RP and intraoperative photodynamic therapy (PDT) for mesothelioma.

Methods: Thirty-eight patients (42–81 years) underwent RP-PDT. Thirty five of 38 (92%) patients also received systemic therapy. Standard statistical techniques were used for analysis.

Results: Thirty seven of 38 (97%) patients had stage III/IV cancer (according to the American Joint Committee on Cancer [AJCC manual 7th Edition, 2010]) and 7/38 (18%) patients had nonepithelial subtypes. Macroscopic complete resection was achieved in 37/38 (97%) patients. There was 1 postoperative mortality (stroke). At a median follow-up of 34.4 months, the median survival was 31.7 months for all 38 patients, 41.2 months for the 31/38 (82%) patients with epithelial subtypes, and 6.8 months for the 7/38 (18%) patients with nonepithelial subtypes. Median progression-free survival (PFS) was 9.6, 15.1, and 4.8 months, respectively. The median survival and PFS for the 20/31 (64%) patients with N2 epithelial disease were 31.7 and 15.1 months, respectively.

Conclusions: It was possible to achieve a macroscopic complete resection using lung-sparing surgery in 97% of these patients with stage III/IV disease. The survival we observed with this approach was unusually long for the patients with the epithelial subtype but, interestingly, the PFS was not. The reason for this prolonged survival despite recurrence is not clear but is potentially related to preservation of the lung or some PDT-induced effect, or both. We conclude that the results of this lung-sparing approach are safe, encouraging, and warrant further investigation.

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