Photodynamic therapy for lung cancer and malignant pleural mesothelioma

Our plain-English summary of Photodynamic therapy for lung cancer and malignant pleural mesothelioma, by C.B. Simone, K.A. Cengel (Seminars in Oncology, 2014).

The study

• Authors: C.B. Simone, K.A. Cengel
• Journal: Seminars in Oncology
• Published: 2014;41(6):820-30
• Type of article: Review
• Cited by: 97 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Photodynamic therapy (PDT) is a form of non-ionizing radiation therapy that uses a drug, called a photosensitizer, combined with light to produce singlet oxygen ((1)O2) that can exert anti-cancer activity through apoptotic, necrotic, or autophagic tumor cell death. PDT is increasingly being used to treat thoracic malignancies. For early-stage non-small cell lung cancer (NSCLC), PDT is primarily employed as an endobronchial therapy to definitively treat endobronchial or roentgenographically occult tumors. Similarly, patients with multiple primary lung cancers may be definitively treated with PDT. For advanced or metastatic NSCLC and small cell lung cancer (SCLC), PDT is primarily employed to palliate symptoms from obstructing endobronchial lesions causing airway compromise or hemoptysis. PDT can be used in advanced NSCLC to attempt to increase operability or to reduce the extent of operation intervention required, and selectively to treat pleural dissemination intraoperatively following macroscopically complete surgical resection. Intraoperative PDT can be safely combined with macroscopically complete surgical resection and other treatment modalities for malignant pleural mesothelioma (MPM) to improve local control and prolong survival. This report reviews the mechanism of and rationale for using PDT to treat thoracic malignancies, details prospective and major retrospectives studies of PDT to treat NSCLC, SCLC, and MPM, and describes improvements in and future roles and directions of PDT.

Copyright © 2014 Elsevier Inc. All rights reserved.

In plain English

This article was a review, not a new study. The authors explained how photodynamic therapy (PDT) works and summarized published studies of it for non-small cell lung cancer, small cell lung cancer and malignant pleural mesothelioma. PDT uses a drug that is activated by light. Asbestos exposure was mentioned only as background to mesothelioma. In the only randomized phase III trial of PDT for mesothelioma, all 63 patients had debulking surgery and postoperative cisplatin, interferon alpha-2b and tamoxifen. Adding intraoperative PDT did not change median survival (14.1 versus 14.4 months). A University of Pennsylvania study of 38 patients treated with radical pleurectomy and PDT reported a median survival of 31.7 months, and 41.2 months for patients with epithelial histology. Another study linked PDT to increased toxicity and one death. For small cell lung cancer, the authors described the literature as extremely limited. The authors concluded that intraoperative PDT can be safely combined with surgery for malignant pleural mesothelioma. They wrote that it may improve local control and potentially prolong survival in selected patients after a macroscopically complete resection.

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: Narrative review of the mechanism of photodynamic therapy and of published prospective and retrospective clinical studies
• Who was studied: Published studies of PDT in patients with non-small cell lung cancer, small cell lung cancer and malignant pleural mesothelioma. The review did not study its own patient group.
• Exposure: The review concerns a treatment (photodynamic therapy), not asbestos exposure. Asbestos is mentioned only as background: many mesothelioma patients present at an advanced age after a long latency period following asbestos exposure.
• Main results:
  • In the National Cancer Institute randomized phase III trial reviewed, 63 patients were randomized to receive or not receive intraoperative PDT. All patients had maximum debulking surgery and postoperative cisplatin, interferon alpha-2b and tamoxifen immunochemotherapy. PDT did not influence median survival (14.1 months v 14.4 months) or median progression-free time (8.5 months v 7.7 months).
  • In a reviewed phase II study of 40 mesothelioma patients treated with extrapleural pneumonectomy or pleurectomy plus PDT, median survival was 36 months for stage I–II patients (13 patients). It was 10 months for those with more advanced disease (24 patients).
  • In a reviewed University of Pennsylvania study of 38 mesothelioma patients treated with radical pleurectomy and intraoperative PDT from 2005–2010, median survival was 31.7 months for the whole group. It was 41.2 months for the 31 patients with epithelial histology. Progression-free survival was 9.6 months.
  • In a reviewed phase I/II dose escalation study of 28 patients with mostly advanced mesothelioma, PDT was associated with increased toxicity and accounted for one death shortly after surgery.
  • In a reviewed nonrandomized study, 14 mesothelioma patients treated with decortication and PDT were less likely to have tumor regrowth 6 months after surgery than 9 patients not treated with PDT (29% v 73%).
  • In a reviewed UK study of 100 patients with advanced bronchogenic carcinoma and airway blockage, PDT decreased endoluminal obstruction on average from 85.8% to 17.5%.
• The authors' conclusion: The authors concluded that intraoperative PDT can be safely combined with surgery and other treatments for malignant pleural mesothelioma. They wrote that it appears promising and may improve local control and potentially prolong survival in properly selected patients who can undergo a macroscopically complete resection. They added that outcomes appear best when PDT is combined with lung-sparing surgery.
• Limitations the authors state:
  • The authors noted that only one randomized phase III trial had assessed the benefit of PDT for mesothelioma.
  • For small cell lung cancer, the authors noted that the literature is extremely limited and that results in mixed series were not reported separately by histology.

Topics

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

Medical terms in this study, explained in our Lexicon: Lung Cancer, Pleural Mesothelioma, Non-Small Cell Lung Cancer, Small Cell Lung Cancer, Hemoptysis, Surgical Resection.

Related studies

• A Novel Prospective Study Assessing the Combination of Photodynamic Therapy and Proton Radiation Therapy: Safety and Outcomes When Treating Malignant Pleural Mesothelioma — S.R. Rice, Y.R. Li, et al. (2019)
• Real-time light dosimetry for intra-cavity photodynamic therapy: Application for pleural mesothelioma treatment — N. Betrouni, C. Munck, et al. (2017)
• Intrapleural Photodynamic Therapy for Mesothelioma: What Place and Which Future? — C. Munck, S.R. Mordon, et al. (2015)
• Response of Photofrin-sensitised mesothelioma xenografts to photodynamic therapy with 514 nm light — T.H. Foster, S.L. Gibson, et al. (1996)
• Experimental assessment of photodynamic therapy with chlorins for malignant mesothelioma — H.B. Ris, A. Giger, et al. (1997)
• Fluence plays a critical role on the subsequent distribution of chemotherapy and tumor growth delay in murine mesothelioma xenografts pre-treated by photodynamic therapy — Y. Wang, X. Wang, et al. (2015)

Browse more research in Seminars in Oncology, or return to medical research.