Department of Surgery, Division of Thoracic Surgery, Penn-Presbyterian Medical Center, University of Pennsylvania, and Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Ann Thorac Surg. 2011 Jun;91(6):1738-45. doi: 10.1016/j.athoracsur.2011.02.062.
Photodynamic therapy (PDT) is a light-based cancer treatment that acts to a depth of several millimeters into tissue. This study reviewed the results of patients who underwent a macroscopic complete resection, by two different surgical techniques, and intraoperative PDT as a treatment for malignant pleural mesothelioma.
From 2004 to 2008, 28 patients with malignant pleural mesothelioma underwent macroscopic complete resection, 14 by modified extrapleural pneumonectomy (MEPP) and 14 by radical pleurectomy (RP) and intraoperative PDT. The surgical technique evolved over this period such that 13 of the last 16 patients underwent lung-sparing procedures, even in the setting of large-bulk tumors.
Demographics in the MEPP and RP cohorts were similar in age, sex, stage, nodal status, histology, and adjuvant treatments. Stage III/IV disease was present in 12 of 14 patients (86%), with 50% or more with +N2 disease. The median overall survival for the MEPP group was 8.4 months, but has not yet been reached for the RP group at a median follow-up of 2.1 years.
In addition to the inherent advantages of sparing the lung, RP plus PDT yielded a superior overall survival than MEPP plus PDT in this series. The overall survival for the RP plus PDT group was, for unclear reasons, superior to results reported in many surgical series, especially for a cohort with such advanced disease. Given these results, we believe RP plus PDT is a reasonable option for appropriate patients pursuing a surgical treatment for malignant pleural mesothelioma and that this procedure can serve as the backbone of surgically based multimodal treatments.
光动力疗法（PDT）是一种基于光的癌症治疗方法，可作用于组织的几毫米深处。本研究回顾了接受两种不同手术技术和术中 PDT 进行的宏观完全切除的患者的结果，以治疗恶性胸膜间皮瘤。
2004 年至 2008 年，28 例恶性胸膜间皮瘤患者接受了宏观完全切除，其中 14 例采用改良胸膜外全肺切除术（MEPP），14 例采用根治性胸膜切除术（RP）和术中 PDT。在此期间，手术技术不断发展，即使在大体积肿瘤的情况下，最后 16 例患者中有 13 例也进行了肺保留手术。
MEPP 和 RP 两组的人口统计学特征在年龄、性别、分期、淋巴结状态、组织学和辅助治疗方面相似。14 例患者中有 12 例（86%）患有 III/IV 期疾病，其中 50%或更多的患者存在 +N2 疾病。MEPP 组的中位总生存期为 8.4 个月，但在 RP 组的中位随访 2.1 年后尚未达到。
除了保留肺部的固有优势外，在本系列中，RP 加 PDT 的总生存率优于 MEPP 加 PDT。RP 加 PDT 组的总生存率，由于不明原因，优于许多外科系列报告的结果，尤其是对于具有如此晚期疾病的队列。鉴于这些结果，我们认为 RP 加 PDT 是适当患者为恶性胸膜间皮瘤寻求手术治疗的合理选择，并且该手术可以作为基于手术的综合治疗的基础。
