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A Novel Prospective Study Assessing the Combination of Photodynamic Therapy and Proton Radiation Therapy: Safety and Outcomes When Treating Malignant Pleural Mesothelioma
Author(s) -
Rice Stephanie R.,
Li Yun R.,
Busch Theresa M.,
Kim Michele M.,
McNulty Sally,
Dimofte Andrea,
Zhu Timothy C.,
Cengel Keith A.,
Simone Charles B.
Publication year - 2018
Publication title -
photochemistry and photobiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.818
H-Index - 131
eISSN - 1751-1097
pISSN - 0031-8655
DOI - 10.1111/php.13065
Subject(s) - medicine , mesothelioma , surgery , decortication , radiation therapy , gastroenterology , pathology
Malignant pleural mesothelioma remains difficult to treat, with high failure rates despite optimal therapy. We present a novel prospective trial combining proton therapy ( PT ) and photodynamic therapy ( PDT ) and the largest‐ever mesothelioma PT experience ( n = 10). PDT photosensitizers included porfimer sodium (2 mg·kg −1 ; 24 h drug‐light interval) or 2‐[1‐hexyloxyethyl]‐2‐devinyl pyropheophorbide‐a ( HPPH ) (4 mg·m −2 ;48 h) with wavelengths of 630 nm to 60J·cm −2 and 665 nm to 15‐45J·cm −2 , respectively. With a median age of 69 years, patients were predominantly male (90%) with epithelioid histology (100%) and stage III ‐ IV disease (100%). PT was delivered to a median of 55.0 CGE /1.8‐2.0 CGE (range 50–75 CGE ) adjuvantly ( n = 8) or as salvage therapy ( n = 2) following extended pleurectomy/decortication ( ePD )/ PDT . Two‐year local control was 90%, with distant and regional failure rates of 50% and 30%, respectively. All patients received chemotherapy, and four received immunotherapy. Surgical complications included atrial fibrillation ( n = 3), pneumonia ( n = 2), and deep vein thrombosis ( n = 2). Median survival from PT completion was 19.5 months (30.3 months from diagnosis), and 1‐ and 2‐year survival rates were 58% and 29%. No patient experienced CTCAE v4 grade ≥2 acute or late toxicity. Our prolonged survival in very advanced‐stage patients compares favorably to survival for PT without PDT and photon therapy with PDT , suggesting possible spatial or systemic cooperativity and immune effect.