title: Photodynamic therapy and the evolution of a lung-sparing surgical treatment for mesothelioma.
abstract: 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.
authors.affiliation: 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. joseph.friedberg@uphs.upenn.edu
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Friedberg
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Mick
authors.forename: Melissa
authors.initials: M
authors.lastname: Culligan
authors.forename: James
authors.initials: J
authors.lastname: Stevenson
authors.forename: Annemarie
authors.initials: A
authors.lastname: Fernandes
authors.forename: Deborah
authors.initials: D
authors.lastname: Smith
authors.forename: Eli
authors.initials: E
authors.lastname: Glatstein
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hahn
authors.forename: Keith
authors.initials: K
authors.lastname: Cengel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D010778:Photochemotherapy; D010994:Pleura / Q000601:surgery*; D010997:Pleural Neoplasms / Q000628:therapy*; D011013:Pneumonectomy / Q000379:methods*