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Preliminary Report of Photodynamic Therapy for Intraperitoneal Sarcomatosis

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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.

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

    Todd W. Bauer MD, Francis R. Spitz MD & Douglas L. Fraker MD

  2. Department of Radiation Oncology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

    Stephen M. Hahn MD, Alexander Kachur PhD & Eli Glatstein MD

  3. Division of Surgical Oncology, Dept. of Surgery, 4 Silverstein, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104

    Douglas L. Fraker MD

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  1. Todd W. Bauer MD
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  2. Stephen M. Hahn MD
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  3. Francis R. Spitz MD
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  4. Alexander Kachur PhD
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  5. Eli Glatstein MD
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  6. Douglas L. Fraker MD
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Correspondence to Douglas L. Fraker MD.

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Bauer, T.W., Hahn, S.M., Spitz, F.R. et al. Preliminary Report of Photodynamic Therapy for Intraperitoneal Sarcomatosis. Ann Surg Oncol 8, 254–259 (2001). https://doi.org/10.1007/s10434-001-0254-7

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  • DOI: https://doi.org/10.1007/s10434-001-0254-7

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