Malignant pleural metastasis occurs in 15-20% of patients with metastatic disease. The median survival for these patients is 4 months, with a 1-year survival of less than 15%. In an attempt to decrease local recurrence and increase overall survival, surgical debulking and intraoperative hemithoracic photodynamic therapy (PDT) was performed on patients with metastatic pleural malignancies. The objectives were to examine local control and effect on survival.
10 patients (17-74 years old) with metastatic cancer (2 ovarian, 5 sarcoma, 1 thymoma, 1 pheochromocytoma, 1 breast) isolated to one pleural space were enrolled (9/10 bulk disease, 1 effusion alone). 9/10 were proven unresponsive to conventional therapy. Patients received porfirmer sodium (2mg/kg) 24 hours prior to surgery, underwent resection of all gross tumor and received intraoperative hemithoracic illumination with 30 J/cm2 630 nm light (9 thoracotomies, 1 thoracoscopy). Local recurrence was assessed with CT scans every three months.
Due to intraoperative death, 2/5 patients with sarcoma did not receive PDT. One patient with sarcoma is alive at 2.0 months. The remaining 2/5 patients with sarcoma survived 1.9 and 6.5 months, both dying with local recurrences. The patient with pheochromocytoma is alive at 21.0 months postoperatively, but diagnosed with local recurrence at 20.0 months. The patient with thymoma is alive without recurrence at 20.4 months. The patient with metastatic breast cancer is alive at 14.7 months, but with recent brain metastases. One patient with ovarian cancer died after 7.7 months with locally recurrent disease and the other, treated thoracoscopically, was alive with abdominal recurrence at 25.5 months (then lost to follow-up). There were no significant PDT related complications.
In select situations, combining surgery and PDT for patients with secondary cancers involving the pleura may be effective in controlling local recurrence and increasing overall survival. Patients with sarcomas appear to be the most difficult to treat and the least likely to derive significant benefit.
PDT may be an effective adjuvant therapy to decrease local recurrence of pleural metastases.
J.P. Cantor, Photofrin