Preliminary report of photodynamic therapy for intraperitoneal sarcomatosis.

Abstract

INTRODUCTION:

Sarcomatosis is the disseminated intraperitoneal spread of sarcoma. It is a condition for which there is no effective treatment. Photodynamic therapy (PDT) is a cancer treatment modality that uses a photosensitizing agent and laser light to kill cells. We report our preliminary Phase II clinical trial experience using PDT for the treatment of intraperitoneal sarcomatosis.

METHODS:

From May 1997 to December 1998 eleven patients received twelve PDT treatments for intraperitoneal sarcomatosis. Photofrin (PF) 2.5 mg/kg was administered intravenously 48 hours before surgical debulking to a maximum residual tumor size of less than 5 mm. Light therapy was administered at a fluence of 2.5 J/cm2 of 532 nm green light to the mesentery and serosa of the small bowel and colon; 5 J/cm2 of 630 nm red light to the stomach and duodenum; 7.5 J/cm2 of red light to the surface of the liver, spleen, and diaphragms; and 10 J/cm2 of red light to the retroperitoneal gutters and pelvis. Light fluence was measured with an on-line light dosimetry system. Response to treatment was evaluated by abdominal CT scan at 3 and 6 months, diagnostic laparoscopy at 3 to 6 months, and clinical examination every 3 months.

RESULTS:

Adequate tumor debulking required an omentectomy in eight patients (73%), small bowel resection in seven patients (64%), colon resection in four patients (36%), splenectomy in one patient (9%), and a left spermatic cord resection in one patient. Five patients (45%) have no evidence of disease at follow-up (range, 1.7-17.3 months), including patients at 13.8 and 17.3 months examined by CT. Two patients (18%) died from disease progression. Four patients (36%) are alive with disease progression. Toxicities related to PDT included substantial postoperative fluid shifts with volume overload, transient thrombocytopenia, and elevated liver function tests. One patient suffered a postoperative pulmonary embolism complicated by adult respiratory distress syndrome (ARDS).

CONCLUSIONS:

Debulking surgery with intraperitoneal PDT for sarcomatosis is feasible. Preliminary response data suggest prolonged relapse-free survival in some patients. Additional follow-up with more patients will be necessary for full evaluation of the added benefit of PDT and aggressive surgical debulking in these patients.

• Authors: T W Bauer, S M Hahn, F R Spitz, A Kachur, E Glatstein, D L Fraker
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 8 Issue 3 Pg. 254-9 (Apr 2001) ISSN: 1068-9265 [Print] United States
• PMID: 11314943 (Publication Type: Clinical Trial, Clinical Trial, Phase II, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Dihematoporphyrin Ether

Topics

• Adult
• Combined Modality Therapy
• Dihematoporphyrin Ether (adverse effects, therapeutic use)
• Disease-Free Survival
• Female
• Follow-Up Studies
• Hematoporphyrin Photoradiation (methods)
• Humans
• Laparotomy
• Male
• Middle Aged
• Pennsylvania (epidemiology)
• Peritoneal Neoplasms (drug therapy, mortality, surgery)
• Sarcoma (drug therapy, mortality, surgery)
• Survival Rate