Intraoperative photodynamic therapy for malignant mesothelioma

Our plain-English summary of Intraoperative photodynamic therapy for malignant mesothelioma, by H.I. Pass, Z. Tochner, T. DeLaney, et al (The Annals of Thoracic Surgery, 1990).

The study

• Authors: H.I. Pass, Z. Tochner, T. DeLaney, P. Smith, W. Friauf, E. Glatstein, W. Travis
• Journal: The Annals of Thoracic Surgery
• Published: 1990;50(4):687-8
• Type of article: Case report, Comment, Letter
• Cited by: 36 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this letter, responding to a published report of a giant benign mesothelioma, authors at the National Cancer Institute (Bethesda, Maryland) described intraoperative photodynamic therapy, an approach under investigation at their institution for diffuse pleural malignant mesothelioma. It combined preoperative delivery of a photosensitizer (dihematoporphyrin ether), surgical debulking of tumor to 5 mm thickness by pleurectomy or extrapleural pneumonectomy, and intraoperative delivery of 630-nm laser light. They reported one patient, a 58-year-old man with right-sided diffuse pleural mesothelioma, who underwent extrapleural pneumonectomy 2 days after receiving 2.0 mg/kg of the sensitizer. Light doses were 15 J/cm2 to the chest cavity and 11 J/cm2 to the heart. Operative time was 8 hours, including 37 minutes of laser time. The patient was extubated the next morning. Serum creatinine rose from 90 to 140 µmol/L and returned to normal with hydration within 48 hours. Creatine kinase rose from 44 to 11,030 U/L at 72 hours and was 369 U/L at discharge on the ninth postoperative day. The tumor was a mixed epithelial-fibrous mesothelioma. At follow-up 2 and 4 months after the procedure he needed no oxygen, his wounds had healed and he had returned to work. The authors reported that a phase I trial to determine the maximum tolerated dose was under way and stated that it was too early to comment on efficacy.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This letter to the editor, from a team at the National Cancer Institute in Bethesda, described an experimental treatment for diffuse pleural malignant mesothelioma in one patient. It did not discuss asbestos exposure. A 58-year-old man with right-sided diffuse pleural mesothelioma received 2.0 mg/kg of a light-sensitizing drug, dihematoporphyrin ether. Two days later he underwent extrapleural pneumonectomy, and the remaining tumor was debulked to 5 mm thickness or less. The chest cavity was then treated with 630-nm laser light to a total dose of 15 J/cm2, and the heart to 11 J/cm2. The patient came off the breathing tube the next morning. His serum creatinine rose from 90 to 140 micromoles per litre and returned to normal with hydration over the next 48 hours. Creatine kinase, a muscle enzyme, rose from 44 to 11,030 U/L at 72 hours and later normalized. At follow-up 2 and 4 months later, he needed no oxygen and had returned to work. The authors stated it was too early to comment on efficacy, and that a phase I trial to determine the maximum tolerated dose was underway.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor describing a single treated patient (case description) of an experimental technique
• Who was studied: One 58-year-old man with right-sided diffuse pleural mesothelioma, treated at the authors' institution (National Cancer Institute, Bethesda); dates of treatment not given
• Exposure: No asbestos or other exposure is reported. The letter describes a treatment: 2.0 mg/kg dihematoporphyrin ether given 2 days before extrapleural pneumonectomy, debulking to 5 mm or less, then intraoperative 630-nm laser light (total 15 J/cm2 to the chest cavity, 11 J/cm2 to the heart)
• Main results:
  • The patient was extubated the morning after the operation; total operative time was 8 hours, with 37 minutes of laser time
  • Serum creatinine rose from 90 to 140 micromoles per litre (1.0 to 1.6 mg/dL) on the night of operation and normalized with hydration over the next 48 hours
  • Creatine kinase rose from a baseline of 44 to 11,030 U/L 72 hours after photodynamic therapy. It was all of muscle origin (100% muscle band), and it had fallen to 369 U/L by discharge on the ninth postoperative day. Myoglobin was absent from the urine
  • The removed specimen showed areas of intense pink fluorescence under 514-nm light, and the tumor was a mixed epithelial-fibrous mesothelioma
  • At follow-up 2 and 4 months after the procedure, the patient had no oxygen requirements and all wounds had healed. A chest CT showed only the right hydrothorax, creatine kinase had normalized, and the patient had returned to work
• The authors' conclusion: The authors said it was too early to comment on efficacy. They offered the technique as an innovative approach of interest to thoracic and medical oncologists, and said a phase I trial to determine the maximum tolerated dose was underway at their institution
• Limitations the authors state:
  • The authors state it is too early to judge whether the treatment works
  • The authors state the maximum tolerated dose for use in humans had not yet been determined

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma.

Related studies

• Photodynamic therapy for thoracic malignancies — H.I. Pass, H. Pogrebniak (1992)
• Phase III randomized trial of surgery with or without intraoperative photodynamic therapy and postoperative immunochemotherapy for malignant pleural mesothelioma — H.I. Pass, B.K. Temeck, et al. (1997)
• Radical pleurectomy and intraoperative photodynamic therapy for malignant pleural mesothelioma — J.S. Friedberg, M.J. Culligan, et al. (2012)
• A preclinical model to investigate the role of surgically-induced inflammation in tumor responses to intraoperative photodynamic therapy — R.W. Davis, E. Papasavvas, et al. (2018)
• Photodynamic therapy and the evolution of a lung-sparing surgical treatment for mesothelioma — J.S. Friedberg, R. Mick, et al. (2011)
• Photodynamic therapy for lung cancer and malignant pleural mesothelioma — C.B. Simone, K.A. Cengel (2014)

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