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Pleural Photodynamic Therapy and Surgery in Lung Cancer and Thymoma Patients with Pleural Spread.

Chen KC, Hsieh YS, Tseng YF, Shieh MJ, Chen JS, Lai HS, Lee JM - PLoS ONE (2015)

Bottom Line: Using Kaplan-Meier survival analysis, the 3-year survival rate and the 5-year survival rate were 68.9% and 57.4%, respectively.We compared the PDT lung cancer patients with those receiving chemotherapy or target therapy (n = 51) and found that the PDT group had better survival than non-PDT patients (mean survival time: 39.0 versus 17.6 months; P = .047).With proper patient selection, radical surgical resection combined with intrapleural photodynamic therapy for pleural spread in patients with non-small cell lung cancer or thymoma is feasible and may provide a survival benefit.

View Article: PubMed Central - PubMed

Affiliation: Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.

ABSTRACT
Pleural spread is difficult to treat in malignancies, especially in lung cancer and thymoma. Monotherapy with surgery fails to have a better survival benefit than palliative chemotherapy, the currently accepted treatment. Photodynamic therapy utilizes a photosensitizer to target the tumor site, and the tumor is exposed to light after performing a pleurectomy and tumor resection. However, the benefits of this procedure to lung cancer or thymoma patients are unknown. We retrospectively reviewed the clinical characteristics and treatment outcomes of patients with lung cancer or thymoma with pleural seeding who underwent pleural photodynamic therapy and surgery between 2005 and 2013. Eighteen patients enrolled in this study. The mean patient age was 52.9 ± 12.2 years. Lung cancer was the inciting cancer of pleural dissemination in 10 patients (55.6%), and thymoma in 8 (44.4%). There was no procedure-related mortality. Using Kaplan-Meier survival analysis, the 3-year survival rate and the 5-year survival rate were 68.9% and 57.4%, respectively. We compared the PDT lung cancer patients with those receiving chemotherapy or target therapy (n = 51) and found that the PDT group had better survival than non-PDT patients (mean survival time: 39.0 versus 17.6 months; P = .047). With proper patient selection, radical surgical resection combined with intrapleural photodynamic therapy for pleural spread in patients with non-small cell lung cancer or thymoma is feasible and may provide a survival benefit.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier survival analysis of the patients undergoing PDT vs. non-PDT for pleural spread (P = 0.047).
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pone.0133230.g001: Kaplan-Meier survival analysis of the patients undergoing PDT vs. non-PDT for pleural spread (P = 0.047).

Mentions: There were 10 women and 8 men in our study (Table 1). The mean patient age was 52.9 ± 12.2 years. The inciting cancer of pleural dissemination was lung cancer in 10 patients (55.6%) and thymoma in 8 (44.4%) patients. The average hospital stay was 13.5 ± 4.4 days. The average duration of the operation was 305.1 ± 63.3 minutes. There was no procedure-related mortality. The average follow up time was 38.1 months. Using Kaplan-Meier survival analysis, the 3-year survival rate and 5-year survival rate were 68.9% and 57.4%, respectively. Six out of 10 NSCLC patients treated with PDT died, while one had a local recurrence and one had a distant metastasis. One out of 8 thymoma patients treated with PDT died due to tumor progression by distant metastasis 32 months after initial treatment, one had a local recurrence and 2 had distant metastases. When compared with lung cancer patients treated with chemotherapy, target therapy or radiotherapy without surgical resection and PDT, the survival difference was significant (P = 0.047) (Fig 1). The neoadjuvant and adjuvant treatment profile for the two groups of lung cancer patients with pleural spread is listed in Table 2. There were post-operative ARDS complications in one of our PDT patients. She is a 57-year-old lady who had lung adenocarcinoma with pleural spread. She underwent concurrent chemoradiotherapy before PDT and surgery. The ARDS occurred immediately after the procedure. After medical treatment, the condition gradually improved. Other minor complications included prolonged air-leakage (one patient) and skin redness (two patients). The complications were successfully treated using medication. Seven patients died during the follow-up period. One patient died due to pneumonia and the other deaths were cancer-related. Regarding the cancer-related failure pattern (n = 6), one was a local recurrence and the other 5 were distant metastases.


Pleural Photodynamic Therapy and Surgery in Lung Cancer and Thymoma Patients with Pleural Spread.

Chen KC, Hsieh YS, Tseng YF, Shieh MJ, Chen JS, Lai HS, Lee JM - PLoS ONE (2015)

Kaplan-Meier survival analysis of the patients undergoing PDT vs. non-PDT for pleural spread (P = 0.047).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4507875&req=5

pone.0133230.g001: Kaplan-Meier survival analysis of the patients undergoing PDT vs. non-PDT for pleural spread (P = 0.047).
Mentions: There were 10 women and 8 men in our study (Table 1). The mean patient age was 52.9 ± 12.2 years. The inciting cancer of pleural dissemination was lung cancer in 10 patients (55.6%) and thymoma in 8 (44.4%) patients. The average hospital stay was 13.5 ± 4.4 days. The average duration of the operation was 305.1 ± 63.3 minutes. There was no procedure-related mortality. The average follow up time was 38.1 months. Using Kaplan-Meier survival analysis, the 3-year survival rate and 5-year survival rate were 68.9% and 57.4%, respectively. Six out of 10 NSCLC patients treated with PDT died, while one had a local recurrence and one had a distant metastasis. One out of 8 thymoma patients treated with PDT died due to tumor progression by distant metastasis 32 months after initial treatment, one had a local recurrence and 2 had distant metastases. When compared with lung cancer patients treated with chemotherapy, target therapy or radiotherapy without surgical resection and PDT, the survival difference was significant (P = 0.047) (Fig 1). The neoadjuvant and adjuvant treatment profile for the two groups of lung cancer patients with pleural spread is listed in Table 2. There were post-operative ARDS complications in one of our PDT patients. She is a 57-year-old lady who had lung adenocarcinoma with pleural spread. She underwent concurrent chemoradiotherapy before PDT and surgery. The ARDS occurred immediately after the procedure. After medical treatment, the condition gradually improved. Other minor complications included prolonged air-leakage (one patient) and skin redness (two patients). The complications were successfully treated using medication. Seven patients died during the follow-up period. One patient died due to pneumonia and the other deaths were cancer-related. Regarding the cancer-related failure pattern (n = 6), one was a local recurrence and the other 5 were distant metastases.

Bottom Line: Using Kaplan-Meier survival analysis, the 3-year survival rate and the 5-year survival rate were 68.9% and 57.4%, respectively.We compared the PDT lung cancer patients with those receiving chemotherapy or target therapy (n = 51) and found that the PDT group had better survival than non-PDT patients (mean survival time: 39.0 versus 17.6 months; P = .047).With proper patient selection, radical surgical resection combined with intrapleural photodynamic therapy for pleural spread in patients with non-small cell lung cancer or thymoma is feasible and may provide a survival benefit.

View Article: PubMed Central - PubMed

Affiliation: Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.

ABSTRACT
Pleural spread is difficult to treat in malignancies, especially in lung cancer and thymoma. Monotherapy with surgery fails to have a better survival benefit than palliative chemotherapy, the currently accepted treatment. Photodynamic therapy utilizes a photosensitizer to target the tumor site, and the tumor is exposed to light after performing a pleurectomy and tumor resection. However, the benefits of this procedure to lung cancer or thymoma patients are unknown. We retrospectively reviewed the clinical characteristics and treatment outcomes of patients with lung cancer or thymoma with pleural seeding who underwent pleural photodynamic therapy and surgery between 2005 and 2013. Eighteen patients enrolled in this study. The mean patient age was 52.9 ± 12.2 years. Lung cancer was the inciting cancer of pleural dissemination in 10 patients (55.6%), and thymoma in 8 (44.4%). There was no procedure-related mortality. Using Kaplan-Meier survival analysis, the 3-year survival rate and the 5-year survival rate were 68.9% and 57.4%, respectively. We compared the PDT lung cancer patients with those receiving chemotherapy or target therapy (n = 51) and found that the PDT group had better survival than non-PDT patients (mean survival time: 39.0 versus 17.6 months; P = .047). With proper patient selection, radical surgical resection combined with intrapleural photodynamic therapy for pleural spread in patients with non-small cell lung cancer or thymoma is feasible and may provide a survival benefit.

No MeSH data available.


Related in: MedlinePlus