Photodynamic Therapy as an Innovative Treatment for Malignant Pleural Mesothelioma
Section snippets
Photodynamic Therapy
PDT is a light-based cancer treatment that requires three components: a nontoxic photosensitizing compound, oxygen, and visible light.5 Most photosensitizing agents are macrocyclic structures that are chlorin- or porphyrin-based components. Chlorin, for example, is derived from chlorophyll, the compound plants use to capture energy from the sun for photosynthesis. A remarkable aspect of PDT is that each of the three components is completely innocuous alone, but the combination is lethal to
Results
Pleural PDT was first started by Pass and colleagues in the 1980s.29, 30, 31 Ultimately, in the only phase III trial to date, they performed a study comparing maximal debulking surgery and postoperative cisplatin, interferon alpha-2a, and tamoxifen immunochemotherapy with or without intraoperative PDT.32 The type of resection for patients assigned to PDT (n = 25) included 11 pleurectomies and 14 pleuropneumonectomies compared with the non-PDT group (n = 23), which included 12 pleurectomies and
Future Directions for PDT and Pleural Cancers
Given that these recent clinical studies included patients with all subtypes of mesothelioma and nodal status, we believe the local control rates and the survival rates are sufficiently promising to merit ongoing development of this combination of surgical technique and PDT. Clinical studies for the immediate future include rigorous assessment of both pulmonary function and quality of life, especially with respect to the impact of sparing the lung, pericardium, phrenic nerve, and diaphragmatic
Conclusions
PDT is an effective light-based cancer treatment that can be combined with surgery as a treatment for mesothelioma. The small, but real, depth of penetration of the treatment has allowed the technique for achieving a macroscopic complete resection to evolve to a state where natural barriers and functional structures can be preserved. Studies are under way to further evaluate the merit of this approach. In addition, we are actively engaged in research aimed at capitalizing on the unique
References (34)
Macroscopic complete resection: The goal of primary surgery in multimodality therapy for pleural mesothelioma
J Thorac Oncol
(2006)- et al.
A phase I study of extrapleural pneumonectomy and intracavitary intraoperative hyperthermic cisplatin with amifostine cytoprotection for malignant pleural mesothelioma
J Thorac Cardiovasc Surg
(2009) - et al.
Hyperthermic chemoperfusion for the treatment of malignant pleural mesothelioma
Semin Thorac Cardiovasc Surg
(2008) - et al.
The present and future role of photodynamic therapy in cancer treatment
Lancet Oncol
(2004) - et al.
Photodynamic therapy followed by thoracoscopic sleeve lobectomy for locally advanced lung cancer
Ann Thorac Surg
(2008) - et al.
Photodynamic therapy (PDT) for lung cancers
J Thorac Oncol
(2006) - et al.
Endoscopic therapy of dysplasia and early-stage cancers of the esophagus
Semin Radiat Oncol
(2007) - et al.
(The place of photodynamic therapy in gynecology)
Gynecol Obstet Fertil
(2007) Management of BCG failures in superficial bladder cancer: A review
Eur Urol
(2006)- et al.
Innovative therapies: Photodynamic therapy
Thorac Surg Clin
(2004)