Ris H B, Altermatt H J, Inderbitzi R, Hess R, Nachbur B, Stewart J C, Wang Q, Lim C K, Bonnett R, Berenbaum M C
Department of Thoracic and Cardiovascular Surgery, University of Bern, Switzerland.
Br J Cancer. 1991 Dec;64(6):1116-20. doi: 10.1038/bjc.1991.474.
Four patients underwent intraoperative photodynamic therapy after surgery with meso-tetra-(hydroxyphenyl)-chlorin (mTHPC-PDT) for diffuse malignant mesothelioma. Preliminary procedures were performed in two patients in order to establish the efficacy of mTHPC-PDT and to optimise its tumoricidal effect. The tumoricidal effect was related to the mTHPC dose, light dose and the time interval between sensitation and activation. 0.3 mg kg-1 mTHPC activated after 48 h with 10 Joules cm-2 of non-thermal laser light at 650 nm resulted in a 10 mm deep tumour infarction, due to tumour vessel necrosis and thrombosis. The mTHPC tissue concentration was up to 14 times higher in the tumour than in normal tissues. Skin photosensitivity was mild, dose dependent and occurred 3 to 10 days after administration of mTHPC. According to the results obtained, intraoperative mTHPC-PDT was performed following pleuropneumonectomy in two, pleurectomy and lobectomy in one and pleurectomy in one patient. Ten Joules cm-2 were delivered to the diaphragm and the costophrenic sulcus and 5 Joules cm-2 to the remaining thoracic cavity. The postoperative course was marked by loss of appetite, fluid retention, hypoproteinemia and severe chest pain. One patient succumbed from aspiration pneumonia. The remaining patients developed no neural or vascular alterations and no bronchial stump insufficiency during follow-up. mTHPC-PDT following surgical tumour resection deserves further evaluation in good risk patients with diffuse malignant mesothelioma.
四名弥漫性恶性间皮瘤患者在手术后接受了中-四-(羟苯基)-氯卟啉（mTHPC）光动力疗法（mTHPC-PDT）。为确定mTHPC-PDT的疗效并优化其杀肿瘤效果，对两名患者进行了初步操作。杀肿瘤效果与mTHPC剂量、光照剂量以及致敏和激活之间的时间间隔有关。0.3mg/kg的mTHPC在48小时后用650nm的10焦耳/平方厘米非热激光激活，由于肿瘤血管坏死和血栓形成，导致10毫米深的肿瘤梗死。肿瘤组织中mTHPC的浓度比正常组织高14倍。皮肤光敏反应较轻，呈剂量依赖性，在给予mTHPC后3至10天出现。根据获得的结果，两名患者在胸膜肺切除术后、一名患者在胸膜切除和肺叶切除术后、一名患者在胸膜切除术后进行了术中mTHPC-PDT。向膈肌和肋膈沟输送10焦耳/平方厘米，向其余胸腔输送5焦耳/平方厘米。术后病程的特点是食欲不振、液体潴留、低蛋白血症和严重胸痛。一名患者死于吸入性肺炎。其余患者在随访期间未出现神经或血管改变，也未出现支气管残端功能不全。对于弥漫性恶性间皮瘤风险较低的患者，手术切除肿瘤后进行mTHPC-PDT值得进一步评估。
