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Ann Thorac Surg 2003;75:952-959
© 2003 The Society of Thoracic Surgeons

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Original article: general thoracic

A phase I study of Foscan-mediated photodynamic therapy and surgery in patients with mesothelioma

^a Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
^b Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
^c Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
^d Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
^e Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
^f Department of Surgery, Wayne State University, Detroit, Michigan, USA

^* Address reprint requests to Dr Friedberg, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19104-4283, USA
e-mail: joseph.friedberg{at}mail.tju.edu

Presented at the Poster Session of the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

BACKGROUND: Photodynamic therapy (PDT) is a light-based cancer treatment that, in the correct setting, can be delivered intraoperatively as an adjuvant therapy. A phase I clinical trial combining surgical debulking with Foscan-mediated PDT was performed in patients with malignant pleural mesothelioma. The purpose of the study was to define the toxicities and to determine the maximally tolerated dose (MTD) of Foscan-mediated PDT.

METHODS: A total of 26 patients completed treatment. Tumor debulking was accomplished with either an extrapleural pneumonectomy (7 patients) or a lung-sparing pleurectomy–decortication (19 patients). Patients were injected with Foscan before surgery, and 652 nm light was delivered intraoperatively after completion of surgical debulking. Four light sensors were placed in the chest, allowing delivery of light to a uniform measured dose throughout the hemithorax.

RESULTS: Four dose levels were explored. The MTD was 0.1 mg/kg of Foscan injected 6 days before surgery in combination with 10 J · cm^-2 652 nm light. Dose limiting toxicity at the next higher dose was a systemic capillary leak syndrome leading to death in 2 of 3 patients treated at that dose. Other PDT-related toxicities included wound burns and skin photosensitivity. In all, 14 patients were treated at the MTD without significant complications.

CONCLUSIONS: Foscan-mediated PDT can be safely combined with surgery at the established MTD. Unlike most other surgery-based multimodal treatments for mesothelioma, Foscan-mediated PDT affords the option, in selected patients, of accomplishing tumor debulking with a lung-sparing procedure rather than an extrapleural pneumonectomy. A phase II study is warranted.

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