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A phase I study of Foscan-mediated photodynamic therapy and surgery in patients with mesothelioma.
[systemic capillary leak syndrome]
Photodynamic
therapy
(
PDT
)
is
a
light-based
cancer
treatment
that
,
in
the
correct
setting
,
can
be
delivered
intraoperatively
as
an
adjuvant
therapy
.
A
phase
I
clinical
trial
combining
surgical
debulking
with
Foscan-mediated
PDT
was
performed
in
patients
with
malignant
pleural
mesothelioma
.
The
purpose
of
the
study
was
to
define
the
toxicities
and
to
determine
the
maximally
tolerated
dose
(
MTD
)
of
Foscan-mediated
PDT
.
A
total
of
26
patients
completed
treatment
.
Tumor
debulking
was
accomplished
with
either
an
extrapleural
pneumonectomy
(
7
patients
)
or
a
lung
-sparing
pleurectomy-decortication
(
19
patients
)
.
Patients
were
injected
with
Foscan
before
surgery
,
and
652
nm
light
was
delivered
intraoperatively
after
completion
of
surgical
debulking
.
Four
light
sensors
were
placed
in
the
chest
,
allowing
delivery
of
light
to
a
uniform
measured
dose
throughout
the
hemithorax
.
F
our
dose
levels
were
explored
.
The
MTD
was
0
.
1
mg
/
kg
of
Foscan
injected
6
days
before
surgery
in
combination
with
10
J
x
cm
(
-
2
)
652
nm
light
.
Dose
limiting
toxicity
at
the
next
higher
dose
was
a
systemic
capillary
leak
syndrome
leading
to
death
in
2
of
3
patients
treated
at
that
dose
.
Other
PDT
-related
toxicities
included
wound
burns
and
skin
photosensitivity
.
In
all
,
14
patients
were
treated
at
the
MTD
without
significant
complications
.
Foscan-mediated
PDT
can
be
safely
combined
with
surgery
at
the
established
MTD
.
Unlike
most
other
surgery-based
multimodal
treatments
for
mesothelioma
,
Foscan-mediated
PDT
affords
the
option
,
in
selected
patients
,
of
accomplishing
tumor
debulking
with
a
lung
-sparing
procedure
rather
than
an
extrapleural
pneumonectomy
.
A
phase
II
study
is
warranted
.
Diseases
Validation
Diseases presenting
"lung-sparing procedure"
symptom
systemic capillary leak syndrome
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