Phase II trial of debulking surgery and photodynamic therapy for disseminated intraperitoneal tumors.
BACKGROUND
Photodynamic therapy (PDT) combines photosensitizer drug, oxygen, and laser light to kill tumor cells on surfaces. This is the initial report of our phase II trial, designed to evaluate the effectiveness of surgical debulking and PDT in carcinomatosis and sarcomatosis.


METHODS
Fifty-six patients were enrolled between April 1997 and January 2000. Patients were given Photofrin (2.5 mg/kg) intravenously 2 days before tumor-debulking surgery. Laser light was delivered to all peritoneal surfaces. Patients were followed with CT scans and laparoscopy to evaluate responses to treatment.


RESULTS
Forty-two patients were adequately debulked at surgery; these comprise the treatment group. There were 14 GI malignancies, 12 ovarian cancers and 15 sarcomas. Actuarial median survival was 21 months. Median time to recurrence was 3 months (range, 1-21 months). The most common serious toxicities were anemia (38%), liver function test (LFT) abnormalities (26%), and gastrointestinal toxicities (19%), and one patient died.


CONCLUSIONS
Photofrin PDT for carcinomatosis has been successfully administered to 42 patients, with acceptable toxicity. The median survival of 21 months exceeds our expectations; however, the relative contribution of surgical resection versus PDT is unknown. Deficiencies in photosensitizer delivery, tissue oxygenation, or laser light distribution leading to recurrences may be addressed through the future use of new photosensitizers.
Hendren
S K
SK
Department of Surgery, University of Pennsylvania, Philadelphia 19104, USA.
Hahn
S M
SM
Spitz
F R
FR
Bauer
T W
TW
Rubin
S C
SC
Zhu
T
T
Glatstein
E
E
Fraker
D L
DL
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy / Q000601:surgery*; D003131:Combined Modality Therapy; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D010778:Photochemotherapy; D012509:Sarcoma / Q000188:drug therapy / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D017323:Dihematoporphyrin Ether