title: Photodynamic therapy enhanced by hyperbaric oxygenation in palliation of malignant pleural mesothelioma: clinical experience.
abstract: BACKGROUND
  Surgical debulking followed by radiotherapy/chemotherapy are the standards in the palliative treatment schedule of malignant pleural mesothelioma. The aim of this study was to evaluate the additional effect of intraoperative photodynamic therapy (PDT) under hyperbaric oxygenation (HBO) if compared to decortication alone.
  
  
  METHODS
  From January 1993 to August 2003, decortication was done in 34 patients (28 males, 6 females; mean age: 65 years) suffering from advanced malignant pleural mesothelioma. Twenty-two patients received additional intraoperative PDT under HBO. The surgery and PDT/HBO was done 48h after photosensitization with a polyhematoporphyrin, 2mg/kg BW using a diode laser delivering red light at 630nm through a microlens. The light dose was calculated for 300J at a distance of 1cm from the tumour surface.
  
  
  RESULTS
  At 6-month follow-up the Karnofsky performance status showed no significant difference (P≥0.05) between both groups. CT scans documented focal regrowth of the tumour after 6 months in 10/12 cases of the non-PDT group. However, in the PDT group tumour regrowth was detected in only 9/22 cases at 6-month follow-up. Survival analysis showed a significant advantage for the group with PDT (log-rank test: P=0.0179).
  
  
  CONCLUSIONS
  Although the study includes only a small number of patients, it indicates that additional PDT/HBO represents a safe and technically feasible approach in the palliative setting of advanced malignant mesothelioma of the pleura.
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, University of Medicine, A-8036 Graz, Austria.
authors.forename: Veronika
authors.initials: V
authors.lastname: Matzi
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, University of Medicine, A-8036 Graz, Austria.
authors.forename: Alfred
authors.initials: A
authors.lastname: Maier
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, University of Medicine, A-8036 Graz, Austria.
authors.forename: Oliver
authors.initials: O
authors.lastname: Sankin
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, University of Medicine, A-8036 Graz, Austria.
authors.forename: Jörg
authors.initials: J
authors.lastname: Lindenmann
authors.affiliation: Department of Pneumology, LKH Hörgas-Enzenbach, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Woltsche
authors.affiliation: Department of Dermatology, University of Medicine, A-8036 Graz, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Smolle
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, University of Medicine, A-8036 Graz, Austria.
authors.forename: Freyja Maria
authors.initials: FM
authors.lastname: Smolle-Jüttner