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Phase II Trial of Pleural Photodynamic Therapy and Surgery for Patients With Non–Small-Cell Lung Cancer With Pleural Spread

From the Department of Surgery, Thomas Jefferson University Hospital; and the Departments of Biostatistics and Epidemiology, Medicine, and Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA

Address reprint requests to Stephen M. Hahn, MD, 3400 Spruce St, 2 Donner, Philadelphia, PA 19104-4283; e-mail: hahn{at}xrt.upenn.edu

PURPOSE: Non—small-cell lung cancer (NSCLC) with pleural spread is incurable, with median survival rates ranging from 6 to 9 months. Surgery alone fails to locally control this disease or extend survival beyond the accepted treatment, palliative chemotherapy.

METHODS: We conducted a phase II trial to evaluate the effects on local control and survival of combining surgery with intraoperative photodynamic therapy (PDT), a light-based cancer treatment, in patients with NSCLC with pleural spread. Patients received porfimer sodium (2 mg/kg), 24 hours before surgery, at which time all gross tumor was resected and followed by illumination of the hemithorax with 630 nm light to a measured dose of 30 J/cm². Photosensitizer levels in tumor and surrounding normal tissue were measured.

RESULTS: Twenty-two patients with NSCLC were enrolled; 17 underwent complete debulking and PDT, three underwent partial debulking/PDT, and two patients were unresectable. Local control of pleural disease at 6 months was achieved in 11 of 15 (73.3%; 95% CI, 44.9% to 92.2%) assessable patients. Median overall survival for all 22 patients was 21.7 months (95% CI, 17.7 to 25.8 months). Measured levels of porfimer sodium in tumor were greater than those measured in normal tissues, with ratios ranging from 1.19 to 22.42.

CONCLUSION: Our results indicate surgery and PDT can be performed safely with very good local control. The median survival of 21.7 months, calculated from the time of surgery and PDT is encouraging. Further evaluation of this therapy is warranted.

Supported in part by National Institutes of Health grant PO1 CA 87971.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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