Photodynamic therapy enhanced by hyperbaric oxygenation in palliation of malignant pleural mesothelioma: clinical experience.

ABSTRACT

INTRODUCTION: Surgical debulking followed by radiotherapy/chemotherapy are the standards in the palliative treatment schedule of malignant pleural mesothelioma. The aim of this study was to evaluate the additional effect of intraoperative photodynamic therapy (PDT) under hyperbaric oxygenation (HBO) if compared to decortication alone. PATIENTS AND METHODS: From January 1993 to August 2003, decortication was done in 34 patients (28 males, 6 females; mean age 65 years) suffering from advanced malignant pleural mesothelioma. Twenty-two patients received additional intraoperative PDT under HBO. The surgery and PDT/HBO was done 48h after photosensitization with a polyhematoporphyrin, 2mg/kg BW using a diode laser delivering red light at 630nm through a microlens. The light dose was calculated for 300J at a distance of 1cm from the tumour surface. RESULTS: At 6-month follow-up the Karnofsky performance status showed no significant difference (P≥0.05) between both groups. CT scans documented focal regrowth of the tumour after 6 months in 10/12 cases of the non-PDT group. However, in the PDT group tumour regrowth was detected in only 9/22 cases at 6-month follow-up. Survival analysis showed a significant advantage for the group with PDT (log-rank test P=0.0179). CONCLUSION: Although the study includes only a small number of patients, it indicates that additional PDT/HBO represents a safe and technically feasible approach in the palliative setting of advanced malignant mesothelioma of the pleura.