Photodynamic Therapy and the Evolution of a Lung-Sparing Surgical Treatment for Mesothelioma
Photodynamic Therapy and the Evolution of a Lung-Sparing Surgical Treatment for Mesothelioma
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DOI：
10.1016/j.athoracsur.2011.02.062
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发表时间：
2011-06-01
影响因子：
4.6
通讯作者：
Cengel, Keith
中科院分区：
文献类型：
--
作者：
Friedberg, Joseph S.;Mick, Rosemarie;Cengel, Keith
背景光动力疗法（PDT）是一种基于光的癌症治疗，作用于组织中几毫米的深度。本研究回顾了两种不同的手术技术进行肉眼完全切除的患者的结果，以及术中PDT作为恶性胸膜间皮瘤的治疗方法。2004年至2008年，28例恶性胸膜间皮瘤患者接受了肉眼完全切除术，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。手术技术在此期间不断发展，最后16例患者中有13例接受了保留肺的手术，即使是在大体积肿瘤的情况下。MEPP和RP队列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%）存在III/IV期疾病，其中50%或更多患者存在+N2疾病。MEPP组的中位总生存期为8.4个月，但RP组的中位随访时间为2.1年，尚未达到。除了保留肺的固有优势外，RP加PDT在该系列中的总生存率上级MEPP加PDT。RP加PDT组的总生存率（原因不明）上级优于许多手术系列报告的结果，尤其是对于这种晚期疾病的队列。鉴于这些结果，我们认为RP加PDT是一个合理的选择，为适当的患者寻求手术治疗恶性胸膜间皮瘤，这种程序可以作为骨干手术为基础的多模式治疗。(Ann Thorac Surg 2011;91：1738-46）（C）2011年，胸外科医师协会
Background. 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.Methods. 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.Results. 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.Conclusions. 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. (Ann Thorac Surg 2011;91:1738-46) (C) 2011 by The Society of Thoracic Surgeons