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Radical pleurectomy and intraoperative photodynamic therapy for malignant pleural mesothelioma
Joseph S Friedberg1, Melissa J Culligan, Rosemarie Mick
1Division of Thoracic Surgery, Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. joseph.friedberg@uphs.upenn.edu
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.
Insights
Radical pleurectomy with intraoperative photodynamic therapy (RP-PDT) achieved complete resection in 97% of mesothelioma patients. This lung-sparing approach showed promising survival for epithelial subtypes, warranting further investigation.
Area of Science:
- Thoracic Surgery
- Oncology
- Photodynamic Therapy
Background:
- Radical pleurectomy (RP) for mesothelioma is often deemed technically challenging or unsuitable for patients unable to tolerate pneumonectomy.
- This study reviews the experience with RP combined with intraoperative photodynamic therapy (PDT) for mesothelioma treatment.
Purpose of the Study:
- To evaluate the feasibility and outcomes of radical pleurectomy combined with intraoperative photodynamic therapy (RP-PDT) for mesothelioma.
- To assess the survival and progression-free survival (PFS) in patients undergoing this lung-sparing surgical approach.
Main Methods:
- Thirty-eight patients (42-81 years) with mesothelioma underwent RP-PDT.
- The majority of patients (92%) also received systemic therapy.
- Standard statistical methods were employed for data analysis.
Main Results:
- Macroscopic complete resection was achieved in 97% of patients (37/38).
- Median survival was 31.7 months overall, with significantly longer survival for epithelial subtypes (41.2 months) compared to nonepithelial subtypes (6.8 months).
- Median progression-free survival (PFS) was 9.6 months overall, with 15.1 months for epithelial subtypes.
Conclusions:
- Radical pleurectomy with intraoperative photodynamic therapy (RP-PDT) enables complete resection in most stage III/IV mesothelioma patients.
- The observed survival for epithelial subtypes is encouraging, though PFS requires further understanding, potentially linked to lung preservation or PDT effects.
- This lung-sparing RP-PDT approach is safe, yields encouraging results, and merits further research.
