Ris H B, Altermatt H J, Nachbur B, Stewart C M, Wang Q, Lim C K, Bonnett R, Althaus U
Department of Thoracic and Cardiovascular Surgery, University of Bern, Switzerland.
Lasers Surg Med. 1996;18(1):39-45. doi: 10.1002/(SICI)1096-9101(1996)18:1<39::AID-LSM5>3.0.CO;2-S.
Since there is no satisfactory treatment modality for diffuse malignant mesothelioma of the chest, we assessed surgical tumor resection followed by intraoperative photodynamic therapy with mTHPC in a phase I study.
STUDY DESIGN/MATERIALS AND METHODS: Since 1990, eight patients have undergone intraoperative photodynamic therapy with m-tetrahydroxyphenylchlorin (mTHPC-PDT) following thoracotomy and surgical tumor resection.
mTHPC-PDT-mediated tumor necrosis was characterized by tumor infarction due to tumor vessel necrosis and thrombosis, and its extent depended on drug-light conditions; 650 nm light delivered at 0.1 W/cm2 for 10 J/cm2 48 h after iv administration of 0.3 mg mTHPC/kg resulted in a 10-mm-deep complete tumor necrosis. Skin photosensitivity was related to the drug dose applied and occurred up to 17 days after iv administration of 0.3 mg mTHPC/kg, mTHPC-PDT of brachial plexus infiltrated by mesothelioma resulted in pain relief without deterioration of nerve function.
Tumor resection and intraoperative mTHPC-PDT of the chest cavity is feasible under clinical conditions and offers local tumor control of sites involved. However, distant tumor spread was not prevented by this combined treatment modality and optimization of mTHPC-PDT is warranted for further intraoperative application.
由于对于胸部弥漫性恶性间皮瘤尚无令人满意的治疗方式，我们在一项I期研究中评估了手术肿瘤切除联合术中使用mTHPC进行光动力治疗的效果。
研究设计/材料与方法：自1990年以来，8例患者在开胸手术切除肿瘤后接受了术中使用间四羟基苯基氯卟啉（mTHPC-PDT）的光动力治疗。
mTHPC-PDT介导的肿瘤坏死表现为肿瘤血管坏死和血栓形成导致的肿瘤梗死，其范围取决于药物-光照条件；静脉注射0.3mg mTHPC/kg后48小时，以0.1W/cm²的功率照射650nm光，剂量为10J/cm²，可导致10mm深度的完全肿瘤坏死。皮肤光敏反应与所用药物剂量有关，在静脉注射0.3mg mTHPC/kg后长达17天出现，间皮瘤浸润的臂丛神经进行mTHPC-PDT可缓解疼痛且不使神经功能恶化。
在临床条件下，胸腔肿瘤切除及术中mTHPC-PDT是可行的，并能对受累部位实现局部肿瘤控制。然而，这种联合治疗方式并不能防止远处肿瘤扩散，因此有必要对mTHPC-PDT进行优化以用于进一步的术中应用。
