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Preliminary Report of Photodynamic Therapy for Intraperitoneal Sarcomatosis

From the Departments of Surgery (TWB, FRS, DLF) and Radiation Oncology (SMH, AK, EG), School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Correspondence: Dr. Douglas L. Fraker, Chief, Division of Surgical Oncology, Dept. of Surgery, 4 Silverstein, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104; Fax: 215-662-3629; E-mail: fraker{at}mail.med.upenn.edu

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.

Key Words: Photodynamic therapy • Sarcoma • Photofrin • Laser.

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