Malignant pleural mesothelioma

In the past decade there have been sporadic publications on malignant pleural mesothelioma (MPM). In the present trend of multi-modal treatment for MPM we aim to evaluate the current status of photodynamic therapy (PDT) in the management of MPM through a review study.

Original publications in English were the main source of the review and their material analysed in respect of patient and disease characteristics, PDT methods, mortality and morbidity and survival. Ten articles concerned with 230 patients were analysed and 35 other publications relevant to the study were used for reference. In every case PDT was used as an adjuvant to surgery whose role appeared to be a cyto-reductive procedure of debulking, pleurectomy and decortication (DPD) with/without pulmonary resection. PDT methods used two photosensitisers; Photofrin™ [630 nm laser light] (6 series = 170 patients) or Foscan™ [652 nm laser light] (4 series = 60 patients).

Overall mortality and morbidity was 7.1% (4.9% for Photofrin™ and 13.3% for Foscan™ PDT) and 48% (38% for Photofrin™ and 70% for Foscan™ PDT) respectively. Better survival was achieved for DPD and early stage disease.

Intra-operative (IOP) PDT in MPM is a safe procedure that requires more development and work regarding photosensitisers and light distribution systems for use in intra-pleural situations. The role of surgery in IOP-PDT appears to be cyto-reduction to ≤5 mm residual tumour thickness in order for PDT to be used effectively. Curative intent may depend on the stage of MPM and completeness of cyto-reduction with/without pulmonary resection.

More than half a century after the first descriptions of mesothelioma as a pathologic entity, satisfactory treatment is still elusive. Although relatively uncommon, the incidence of mesothelioma will most likely increase over the next 10-20 years. Advances have been made in understanding the pathogenesis, diagnosis, and staging, but they have not translated into markedly improved survival. Some use palliative treatment as the primary means of therapy even now. On the other hand, a cadre of individuals have studied how surgery, chemotherapy, and radiation therapy affect the disease. Although each individual modality has had limited success by itself, a multimodality approach has been documented to improve survival and quality of life. In addition, intriguing discoveries in immunology and gene profiling and therapy promise hope for further improvement. In this article, we will illustrate the current views on integrating these different approaches and delineate areas of active research.