OPERATION AND INTRACAVITARY PHOTODYNAMIC THERAPY FOR MALIGNANT PLEURAL MESOTHELIOMA - A PHASE-II STUDY

From April 1991 to May 1993, 23 patients entered a phase II clinical s tudy of surgical resection and adjuvant intracavitary photodynamic the rapy for malignant pleural mesothelioma. Two days preoperatively, pati ents received an intravenous injection of 2 mg/kg of the photosensitiz er Photofrin. Six patients underwent a pleuropneumonectomy, and 15 pat ients a pleurectomy, after which intracavitary photodynamic therapy wa s administered. A total light energy dose of 20 to 25 J/cm(2) was give n. In 2 patients the tumor was unresectable due to intrapericardial in vasion. Postoperative complications were noted in more than 50 percent of patients; 2 patients died of postoperative complications. Postoper ative survival was analyzed according to intraoperative staging propos ed by the American Joint Committee for Cancer Staging, published in 19 92. The overall estimated median survival is 12 months; that of stage III and IV patients is 7 months. Five patients with stage I and II dis eases (who had grossly complete resection by pleurectomy) are alive, d isease-free, for 11, 17, 18, 21, and 33 postoperative months. Intraope rative staging is important in carrying out further clinical studies o f malignant pleural mesothelioma.