title: Radical pleurectomy and intraoperative photodynamic therapy for malignant pleural mesothelioma.
abstract: BACKGROUND
  Radical pleurectomy (RP) for mesothelioma is often considered either technically unfeasible or an operation limited to patients who would not tolerate a pneumonectomy. The purpose of this study was to review our experience using RP and intraoperative photodynamic therapy (PDT) for mesothelioma.
  
  
  METHODS
  Thirty-eight patients (42-81 years) underwent RP-PDT. Thirty five of 38 (92%) patients also received systemic therapy. Standard statistical techniques were used for analysis.
  
  
  RESULTS
  Thirty seven of 38 (97%) patients had stage III/IV cancer (according to the American Joint Committee on Cancer [AJCC manual 7th Edition, 2010]) and 7/38 (18%) patients had nonepithelial subtypes. Macroscopic complete resection was achieved in 37/38 (97%) patients. There was 1 postoperative mortality (stroke). At a median follow-up of 34.4 months, the median survival was 31.7 months for all 38 patients, 41.2 months for the 31/38 (82%) patients with epithelial subtypes, and 6.8 months for the 7/38 (18%) patients with nonepithelial subtypes. Median progression-free survival (PFS) was 9.6, 15.1, and 4.8 months, respectively. The median survival and PFS for the 20/31 (64%) patients with N2 epithelial disease were 31.7 and 15.1 months, respectively.
  
  
  CONCLUSIONS
  It was possible to achieve a macroscopic complete resection using lung-sparing surgery in 97% of these patients with stage III/IV disease. The survival we observed with this approach was unusually long for the patients with the epithelial subtype but, interestingly, the PFS was not. The reason for this prolonged survival despite recurrence is not clear but is potentially related to preservation of the lung or some PDT-induced effect, or both. We conclude that the results of this lung-sparing approach are safe, encouraging, and warrant further investigation.
authors.affiliation: Division of Thoracic Surgery, Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. joseph.friedberg@uphs.upenn.edu
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Friedberg
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Culligan
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Mick
authors.forename: James
authors.initials: J
authors.lastname: Stevenson
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hahn
authors.forename: Daniel
authors.initials: D
authors.lastname: Sterman
authors.forename: Salman
authors.initials: S
authors.lastname: Punekar
authors.forename: Eli
authors.initials: E
authors.lastname: Glatstein
authors.forename: Keith
authors.initials: K
authors.lastname: Cengel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008654:Mesothelioma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D010778:Photochemotherapy / Q000379:methods*; D010994:Pleura / Q000473:pathology / Q000601:surgery*; D010997:Pleural Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome