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Mesothelioma study: Lung-sparing surgery, light therapy combination is “encouraging”


Doctors at the University of Pennsylvania used a combination of surgery and photodynamic therapy to extend the lives of patients with advanced pleural mesothelioma.


Photodynamic therapy, or PDT, involves subjecting cancer cells to certain light frequencies using photosensitizing drugs, which are activated by a laser. At Penn, a team of physicians treated 38 patients with PDT following pleurectomy/decortication, a surgery that involves removal of the lung lining and any tumors inside the lining.


Pleurectomy/decortication is a less radical, “lung-sparing” surgery than extrapleural pneumonectomy, which involves removing the lung, chest lining and diaphragm.


Pleurectomy/decortication in conjunction with radiation and chemotherapy has resulted in a median survival rate of more than 20 months in one pervious study, with fewer complications. However, because the surgery may not result in removal of all cancer cells, it’s associated with higher rates of mortality, more complications and longer hospital stays. Many physicians only recommend the technique for patients who would not survive removal of the lung.


But the Penn doctors report that, in their study cohort, the surgery resulted in “macroscopic complete resection” — removal of all tumor cells — in 97 percent of the patients. Moreover, the median survival rate of all 38 patients was 31.7 months. For 31 patients with epithelioid mesothelioma, the most common type of the disease, median survival was 41.2 months. The study also found that the combined therapies slowed tumor growth.


Most patients with stage III or IV mesothelioma, an aggressive cancer caused by asbestos, die within a year of diagnosis.


The researchers, whose work appears in the May issue of The Annals of Thoracic Surgery, conclude that “the results of this lung-sparing approach are safe, encouraging, and warrant further investigation.”