OPERATION AND PHOTODYNAMIC THERAPY FOR PLEURAL MESOTHELIOMA - 6-YEAR FOLLOW-UP

Background. Conventional therapy for pleural mesothelioma has met with disappointing results. Methods. From 1991 to 1996, 40 patients with m alignant pleural mesothelioma were treated with surgical resection fol lowed by immediate intracavitary photodynamic therapy. Results. The se ries included 9 women and 31 men with a mean age of 60 years. Morbidit y and treatment-related mortality rates for the entire series, pleurec tomy, and extrapleural pneumonectomy were 45% and 7.5%, 39% and 3.6%, and 71% and 28.6%, respectively. Median survival and the estimated 2-y ear survival rate for the entire series, stages I and II patients (n = 13), and stages III and IV patients (n = 24) were 15 months and 23%, 36 months and 61%, and 10 months and 0%, respectively. Multivariate an alysis identified stage, length of hospital stay, photodynamic therapy dose, and nodal status as independent prognostic indicators for survi val. Conclusions. Surgical intervention and photodynamic therapy offer good survival results in patients with stage I or II pleural mesothel ioma. For patients in stage III or IV, better treatment modalities nee d to be developed. Improvements in early detection and preoperative st aging are necessary for proper patient selection for treatment. (Ann T horac Surg 1998;66:1128-33) (C) 1998 by The Society of Thoracic Surgeo ns.