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Kondo N, Hasegawa S. Optimal surgery for resectable malignant pleural mesothelioma in the setting of multimodality treatment. Surg Today 2024; 54:663-669. [PMID: 37474704 PMCID: PMC11189979 DOI: 10.1007/s00595-023-02723-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 06/18/2023] [Indexed: 07/22/2023]
Abstract
The surgical treatment of malignant pleural mesothelioma (MPM) involves procedures to achieve macroscopic complete resection, depending on the patient's condition. We reviewed the evolution of surgical approaches for resectable MPM. Since surgery is no more than a single step in the set of processes in multimodality treatment (MMT), we concluded that these procedures should give precedence to lung preservation and minimize resection whenever possible. Postoperative quality of life must be prioritized when the patient can receive appropriate adjuvant therapy.
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Affiliation(s)
- Nobuyuki Kondo
- Department of Thoracic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
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2
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Bille A, Ripley RT, Giroux DJ, Gill RR, Kindler HL, Nowak AK, Opitz I, Pass HI, Wolf A, Rice D, Rusch VW. The International Association for the Study of Lung Cancer Mesothelioma Staging Project: Proposals for the "N" Descriptors in the Forthcoming Ninth Edition of the TNM Classification for Pleural Mesothelioma. J Thorac Oncol 2024:S1556-0864(24)00208-9. [PMID: 38734073 DOI: 10.1016/j.jtho.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer developed an international database to inform potential revisions in the ninth edition of the TNM classification of diffuse pleural mesothelioma (PM). This study analyzed the clinical and pathologic N categories to determine whether revisions were indicated relative to the eighth edition staging system. METHODS Of 7338 PM cases diagnosed from 2013 to 2022 and 3598 met all inclusion criteria for planned analyses. Data on 2836 patients without metastases were included in this study. Overall survival (OS) was measured from date of diagnosis. Patients were included regardless of whether they received neoadjuvant treatment. For the pathologic N analysis, patients who underwent resection (extrapleural pneumonectomy or pleurectomy/decortication) were included. N subgroups were analyzed and OS assessed by the Kaplan-Meier method. RESULTS The existing eighth edition N categories were performed adequately in the ninth edition data set. A median OS advantage was noted for clinical and pathologic N0 versus N1 patients: 23.2 versus 18.5 and 33.8 versus 25.0 months, respectively. Patients with resected pN0 had a 3-year OS of 48%. No difference in OS was noted for single- versus multiple-station nodal metastases. The number of nodal stations sampled at the time of resection was not associated with a difference in OS. CONCLUSIONS Data regarding clinical and pathologic N categories corroborate those used in the eighth edition. No changes in the N categories are recommended in the ninth edition of PM staging system.
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Affiliation(s)
- Andrea Bille
- Thoracic Surgery Department, Guy's Hospital, London, United Kingdom.
| | - R Taylor Ripley
- Department of Thoracic Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Hedy L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Anna K Nowak
- National Centre for Asbestos-Related Diseases, Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital, Zurich, Switzerland
| | - Harvey I Pass
- Department of Thoracic Surgery, NYU Langone Medical Center, New York, New York
| | - Andrea Wolf
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - David Rice
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Li Z, Hannan MN, Sharma AK, Baran TM. Treatment planning for photodynamic therapy of abscess cavities using patient-specific optical properties measured prior to illumination. Phys Med Biol 2024; 69:055031. [PMID: 38316055 PMCID: PMC10900070 DOI: 10.1088/1361-6560/ad2635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/05/2024] [Indexed: 02/07/2024]
Abstract
Photodynamic therapy (PDT) is an effective antimicrobial therapy that we used to treat human abscess cavities in a Phase 1 clinical trial. This trial included pre-PDT measurements of abscess optical properties, which affect light dose (light fluence) at the abscess wall and PDT response. This study simulated PDT treatment planning for 13 subjects that received optical spectroscopy prior to clinical PDT, to determine the impact of measured optical properties on ability to achieve fluence rate targets in 95% of the abscess wall. Retrospective treatment plans were evaluated for 3 conditions: (1) clinically delivered laser power and assumed, homogeneous optical properties, (2) clinically delivered laser power and measured, homogeneous optical properties, and (3) with patient-specific treatment planning using measured, homogeneous optical properties. Treatment plans modified delivered laser power, intra-cavity Intralipid (scatterer) concentration, and laser fiber type. Using flat-cleaved laser fibers, the proportion of subjects achieving 95% abscess wall coverage decreased significantly relative to assumed optical properties when using measured values for 4 mW cm-2(92% versus 38%,p= 0.01) and 20 mW cm-2(62% versus 15%,p= 0.04) thresholds. When measured optical properties were incorporated into treatment planning, the 4 mW cm-2target was achieved for all cases. After treatment planning, optimal Intralipid concentration across subjects was 0.14 ± 0.09%, whereas 1% was used clinically. Required laser power to achieve the 4 mW cm-2target was significantly correlated with measured abscess wall absorption (ρ= 0.7,p= 0.008), but not abscess surface area (ρ= 0.2,p= 0.53). When using spherical diffuser fibers for illumination, both optimal Intralipid concentration (p= 0.0005) and required laser power (p= 0.0002) decreased compared to flat cleaved fibers. At 0% Intralipid concentration, the 4 mW cm-2target could only be achieved for 69% of subjects for flat-cleaved fibers, compared to 100% for spherical diffusers. Based on large inter-subject variations in optical properties, individualized treatment planning is essential for abscess photodynamic therapy. (Clinical Trial Registration: The parent clinical trial from which these data were acquired is registered on ClinicalTrials.gov as 'Safety and Feasibility Study of Methylene Blue Photodynamic Therapy to Sterilize Deep Tissue Abscess Cavities,' with ClinicalTrials.gov identifier NCT02240498).
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Affiliation(s)
- Zihao Li
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
| | - Md Nafiz Hannan
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, United States of America
| | - Ashwani K Sharma
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Timothy M Baran
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
- The Institute of Optics, University of Rochester, Rochester, NY, United States of America
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4
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Li Z, Hannan MN, Sharma AK, Baran TM. Treatment planning for photodynamic therapy of abscess cavities using patient-specific optical properties measured prior to illumination. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.23.23297420. [PMID: 37961683 PMCID: PMC10635177 DOI: 10.1101/2023.10.23.23297420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Photodynamic therapy (PDT) is an effective antimicrobial therapy that we used to treat human abscess cavities in a recently completed Phase 1 clinical trial. This trial included pre-PDT measurements of abscess optical properties, which affect the expected light dose to the abscess wall and eventual PDT response. Purpose The objective of this study was to simulate PDT treatment planning for the 13 subjects that received optical spectroscopy prior to clinical abscess PDT. Our goal was to determine the impact of these measured optical properties on our ability to achieve fluence rate targets in 95% of the abscess wall. Methods During a Phase 1 clinical trial, 13 subjects received diffuse reflectance spectroscopy prior to PDT in order to determine the optical properties of their abscess wall. Retrospective treatment plans seeking to achieve fluence rate targets in 95% of the abscess wall were evaluated for all subjects for 3 conditions: (1) at the laser power delivered clinically with assumed optical properties, (2) at the laser power delivered clinically with measured optical properties, and (3) with patient-specific treatment planning using these measured optical properties. Factors modified in treatment planning included delivered laser power and intra-cavity Intralipid (scatterer) concentration. The effects of laser fiber type were also simulated. Results Using a flat-cleaved laser fiber, the proportion of subjects that achieved 95% abscess wall coverage decreased significantly when incorporating measured optical properties for both the 4 mW/cm 2 (92% vs. 38%, p=0.01) and 20 mW/cm 2 (62% vs. 15%, p=0.04) fluence rate thresholds. However, when measured optical properties were incorporated into treatment planning, a fluence rate of 4 mW/cm 2 was achieved in 95% of the abscess wall for all cases. In treatment planning, the optimal Intralipid concentration across subjects was found to be 0.14 ± 0.09% and the optimal laser power varied from that delivered clinically but with no clear trend (p=0.79). The required laser power to achieve 4 mW/cm 2 in 95% of the abscess wall was significantly correlated with measured µ a at the abscess wall (ρ=0.7, p=0.008), but not abscess surface area (ρ=0.2, p=0.53). When using spherical diffuser fibers as the illumination source, the optimal intralipid concentration decreased to 0.028 ± 0.026% (p=0.0005), and the required laser power decreased also (p=0.0002), compared to flat cleaved fibers. If the intra-cavity lipid emulsion (Intralipid) was replaced with a non-scattering fluid, all subjects could achieve the 4 mW/cm 2 fluence rate threshold in 95% of the abscess wall using a spherical diffuser, while only 69% of subjects could reach the same criterion using a flat cleaved fiber. Conclusions The range of optical properties measured in human abscesses reduced coverage of the abscess wall at desirable fluence rates. Patient-specific treatment planning including these measured optical properties could bring the coverage back to desirable levels by altering the Intralipid concentration and delivered optical power. These results motivate a future Phase 2 clinical trial to directly compare the efficacy of patient-specific-treatment planning with fixed doses of Intralipid and light.Clinical Trial Registration: The parent clinical trial from which these data were acquired is registered on ClinicalTrials.gov as "Safety and Feasibility Study of Methylene Blue Photodynamic Therapy to Sterilize Deep Tissue Abscess Cavities," with ClinicalTrials.gov identifier NCT02240498 .
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Bille A, Jhala H, Ashrafian L, Allison L, Russell M, Fleck R, Nonaka D. Does hyperthermic povidone-iodine lavage increase the apoptotic rate of residual cancer cell in patients with malignant pleural mesothelioma?-a prospective pilot study. Transl Lung Cancer Res 2023; 12:1384-1390. [PMID: 37577311 PMCID: PMC10413027 DOI: 10.21037/tlcr-22-282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/07/2022] [Indexed: 08/15/2023]
Abstract
Background Malignant pleural mesothelioma (MPM) is an incurable, late presenting primary cancer, conferring a survival of 8-14 months. Different intrapleural treatments have been tested as part of a multimodality approach to treat a select group of patients with limited disease, increasing survival. Recently, povidone-iodine has been shown to induce apoptosis in microscopic tumour cells in vitro, with no reported complications. This is the first in vivo study assessing the apoptotic rate caused by intraoperative hyperthermic betadine lavage using routine immunohistochemistry combined with transmission electron microscopy (TEM). Methods We included surgically fit patients aged >18, undergoing minimally invasive video-assisted thoracoscopic surgery (VATS) pleural biopsy between December 2016 and February 2018, for confirmed or presumed pleural malignancy. Parietal pleural biopsies were obtained at 7.5, 15 and 30 minutes after hyperthermic betadine lavage, and compared to pre-lavage biopsy samples, for apoptotic changes. Viable tumour samples underwent histological, immunohistochemical and ultrastructural analysis as well as TEM for features of apoptosis. Results N=6. Median age was 76 years. Median overall survival was 26.7 months. There was no statistical impact on survival of side of disease (left vs. right). There was no significant difference in expressions of markers of apoptotic index pre and post betadine treatment upon immunohistochemical analysis. There was no discernible effect on morphological features of apoptosis seen with betadine treatment, on TEM analysis. No side effects were identified post betadine lavage. Conclusions Although hyperthermic betadine lavage is a safe antiseptic solution with no toxicity when performed intraoperatively, it confers no effect on apoptotic rate or necrosis. It is therefore unlikely that hyperthermic betadine lavage will have an impact on reducing the microscopic residual disease after pleurectomy decortication and enhancing survival.
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Affiliation(s)
- Andrea Bille
- Department of Thoracic Surgery, Guy’s Hospital, London, UK
| | - Hiral Jhala
- Department of Cardiothoracic Surgery, King’s College Hospital, London, UK
| | | | - Leanne Allison
- King’s Centre for Ultrastructural Imaging, King’s College London, London, UK
| | - Matthew Russell
- King’s Centre for Ultrastructural Imaging, King’s College London, London, UK
| | - Roland Fleck
- King’s Centre for Ultrastructural Imaging, King’s College London, London, UK
| | - Daisuke Nonaka
- Department of Histopathology, Guy’s Hospital, London, UK
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6
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Agrawal A, Chaddha U, Shojaee S, Maldonado F. Intrapleural Anticancer Therapy for Malignant Pleural Diseases: Facts or Fiction? Semin Respir Crit Care Med 2023. [PMID: 37308112 DOI: 10.1055/s-0043-1769094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Malignant pleural diseases involves both primary pleural malignancies (e.g., mesothelioma) as well as metastatic disease involving the pleura. The management of primary pleural malignancies remains a challenge, given their limited response to conventional treatments such as surgery, systemic chemotherapy, and immunotherapy. In this article, we aimed to review the management of primary pleural malignancy as well as malignant pleural effusion and assess the current state of intrapleural anticancer therapies. We review the role intrapleural chemotherapy, immunotherapy, and immunogene therapy, as well as oncolytic viral, therapy and intrapleural drug device combination. We further discuss that while the pleural space offers a unique opportunity for local therapy as an adjuvant option to systemic therapy and may help decrease some of the systemic side effects, further patient outcome-oriented research is needed to determine the exact role of these treatments within the armamentarium of currently available options.
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Affiliation(s)
- Abhinav Agrawal
- Division of Pulmonary, Critical Care and Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Udit Chaddha
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samira Shojaee
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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7
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Sun H, Kim MM, Ong YH, Dimoft A, Singhal S, Busch TM, Cengel KA, Zhu TC. Evaluation of Detector Position and Light Fluence Distribution Using an Infrared Navigation System during Pleural Photodynamic Therapy †. Photochem Photobiol 2023; 99:814-825. [PMID: 35996976 PMCID: PMC9947188 DOI: 10.1111/php.13697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
Abstract
Photodynamic therapy (PDT) has been used to treat malignant pleural mesothelioma. Current practice involves delivering light to a prescribed light fluence with a point source, monitored by eight isotropic detectors inside the pleural cavity. An infrared (IR) navigation system was used to track the location of the point source throughout the treatment. The recorded data were used to reconstruct the pleural cavity and calculate the light fluence to the whole cavity. An automatic algorithm was developed recently to calculate the detector positions based on recorded data within an hour. This algorithm was applied to patient case studies and the calculated results were compared to the measured positions, with an average difference of 2.5 cm. Calculated light fluence at calculated positions were compared to measured values. The differences between the calculated and measured light fluence were within 14% for all cases, with a fixed scattering constant and a dual correction method. Fluence-surface histogram (FSH) was calculated for photofrin-mediated PDT to be able to cover 80% of pleural surface area to 50 J cm-2 (83.3% of 60 J cm-2 ). The study demonstrates that it will be possible to eliminate the manual measurement of the detector positions, reducing the patient's time under anesthesia.
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Affiliation(s)
- Hongjing Sun
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Yi Hong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Andreea Dimoft
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Sunil Singhal
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Theresa M. Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
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8
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Sun H, Sourvanos D, Potasek M, Parilov G, Beesonk C, Zhu TC. A real-time IR navigation system for pleural photodynamic therapy with a 3D surface acquisition system. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2023; 12359:123590C. [PMID: 37206987 PMCID: PMC10193932 DOI: 10.1117/12.2650456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Photodynamic therapy (PDT) has been used intraoperatively to treat patients with malignant pleural mesothelioma. For the efficiency of PDT, it is crucial to deliver light doses uniformly. The current procedure utilizes eight light detectors placed inside the pleural cavity to monitor the light. An updated navigation system, combined with a novel scanning system, is developed to provide real-time guidance for physicians during pleural PDT to improve light delivery. The scanning system consists of two handheld three-dimensional (3D) scanners to capture the pleural cavity's surface topographies quickly and precisely before PDT so that the target surface can be identified for real-time light fluence distribution calculation during PDT. An algorithm is developed to further process the scanned volume to denoise for accurate light fluence calculation and rotate the local coordinate system into any desired direction for a clear visualization during the real-time guidance. The navigation coordinate system is registered to the patient coordinate system utilizing at least three markers to track the light source point position within the pleural cavity throughout the treatment. During PDT, the light source position, the scanned pleural cavity, and the light fluence distribution for the cavity's surface will be displayed in 3D and 2D, respectively. For validation, this novel system is tested using phantom studies with a large chest phantom and 3D-printed lung phantoms of different volumes based on a personal CT scan, immersed in a liquid tissue-simulating phantom with different optical properties, and treated with eight isotropic detectors and the navigation system.
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Affiliation(s)
- Hongjing Sun
- Department of Radiation Oncology, Perelman Center for Advanced Medicine (PCAM), University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Dennis Sourvanos
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Innovation and Precision Dentistry, Schools of Engineering and Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Potasek
- Simphotek, Inc., 211 Warren St., Newark, NJ 07103
| | - Gene Parilov
- Simphotek, Inc., 211 Warren St., Newark, NJ 07103
| | - Carl Beesonk
- Simphotek, Inc., 211 Warren St., Newark, NJ 07103
| | - Timothy C. Zhu
- Department of Radiation Oncology, Perelman Center for Advanced Medicine (PCAM), University of Pennsylvania, Philadelphia, PA, 19104, USA
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Bonsall S, Hubbard S, Jithin U, Anslow J, Todd D, Rowding C, Filarowski T, Duly G, Wilson R, Porter J, Turega S, Haywood-Small S. Water-Soluble Truncated Fatty Acid-Porphyrin Conjugates Provide Photo-Sensitizer Activity for Photodynamic Therapy in Malignant Mesothelioma. Cancers (Basel) 2022; 14:5446. [PMID: 36358864 PMCID: PMC9654571 DOI: 10.3390/cancers14215446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/22/2022] [Accepted: 10/28/2022] [Indexed: 03/07/2024] Open
Abstract
Clinical trials evaluating intrapleural photodynamic therapy (PDT) are ongoing for mesothelioma. Several issues still hinder the development of PDT, such as those related to the inherent properties of photosensitizers. Herein, we report the synthesis, photophysical, and photobiological properties of three porphyrin-based photosensitizers conjugated to truncated fatty acids (C5SHU to C7SHU). Our photosensitizers exhibited excellent water solubility and high PDT efficiency in mesothelioma. As expected, absorption spectroscopy confirmed an increased aggregation as a consequence of extending the fatty acid chain length. In vitro PDT activity was studied using human mesothelioma cell lines (biphasic MSTO-211H cells and epithelioid NCI-H28 cells) alongside a non-malignant mesothelial cell line (MET-5A). The PDT effect of these photosensitizers was initially assessed using the colorimetric WST-8 cell viability assay and the mode of cell death was determined via flow cytometry of Annexin V-FITC/PI-stained cells. Photosensitizers appeared to selectively localize within the non-nuclear compartments of cells before exhibiting high phototoxicity. Both apoptosis and necrosis were induced at 24 and 48 h. As our pentanoic acid-derivatized porphyrin (C5SHU) induced the largest anti-tumor effect in this study, we put this forward as an anti-tumor drug candidate in PDT and photo-imaging diagnosis in mesothelioma.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Sarah Haywood-Small
- Biomolecular Sciences Research Centre, Sheffield Hallam University, City Campus, Howard Street, Sheffield S1 1WB, UK
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Choi AY, Singh A, Wang D, Pittala K, Hoang CD. Current State of Pleural-Directed Adjuncts Against Malignant Pleural Mesothelioma. Front Oncol 2022; 12:886430. [PMID: 35586499 PMCID: PMC9108281 DOI: 10.3389/fonc.2022.886430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Multimodality therapy including surgical resection is the current paradigm in treating malignant pleural mesothelioma (MPM), a thoracic surface cancer without cure. The main limitation of all surgical approaches is the lack of long-term durability because macroscopic complete resection (R1 resection) commonly predisposes to locoregional relapse. Over the years, there have been many studies that describe various intrapleural strategies that aim to extend the effect of surgical resection. The majority of these approaches are intraoperative adjuvants. Broadly, there are three therapeutic classes that employ diverse agents. The most common, widely used group of adjuvants are comprised of direct therapeutics such as intracavitary chemotherapy (± hyperthermia). By comparison, the least commonly employed intrathoracic adjuvant is the class comprised of drug-device combinations like photodynamic therapy (PDT). But the most rapidly evolving (new) class with much potential for improved efficacy are therapeutics delivered by specialized drug vehicles such as a fibrin gel containing cisplatin. This review provides an updated perspective on pleural-directed adjuncts in the management of MPM as well as highlighting the most promising near-term technology breakthroughs.
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11
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Li Z, Nguyen L, Bass DA, Baran TM. Effects of patient-specific treatment planning on eligibility for photodynamic therapy of deep tissue abscess cavities: retrospective Monte Carlo simulation study. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:083007. [PMID: 35146973 PMCID: PMC8831513 DOI: 10.1117/1.jbo.27.8.083007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
SIGNIFICANCE Antimicrobial photodynamic therapy (PDT) effectively kills bacterial strains found in deep tissue abscess cavities. PDT response hinges on multiple factors, including light dose, which depends on patient optical properties. AIM Computed tomography images for 60 abscess drainage subjects were segmented and used for Monte Carlo (MC) simulation. We evaluated effects of optical properties and abscess morphology on PDT eligibility and generated treatment plans. APPROACH A range of abscess wall absorptions (μa , wall) and intra-cavity Intralipid concentrations were simulated. At each combination, the threshold optical power and optimal Intralipid concentration were found for a fluence rate target, with subjects being eligible for PDT if the target was attainable with <2000 mW of source light. Further simulations were performed with absorption within the cavity (μa , cavity). RESULTS Patient-specific treatment planning substantially increased the number of subjects expected to achieve an efficacious light dose for antimicrobial PDT, especially with Intralipid modification. The threshold optical power and optimal Intralipid concentration increased with increasing μa , wall (p < 0.001). PDT eligibility improved with patient-specific treatment planning (p < 0.0001). With μa , wall = 0.2 cm - 1, eligibility increased from 42% to 92%. Increasing μa , cavity reduced PDT eligibility (p < 0.0001); modifying the delivered optical power had the greatest impact in this case. CONCLUSIONS MC-based treatment planning greatly increases eligibility for PDT of abscess cavities.
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Affiliation(s)
- Zihao Li
- University of Rochester, The Institute of Optics, Rochester, New York, United States
| | - Lam Nguyen
- University of Rochester, Department of Biomedical Engineering, Rochester, New York, United States
| | - David A. Bass
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, New York, United States
| | - Timothy M. Baran
- University of Rochester, Department of Biomedical Engineering, Rochester, New York, United States
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, New York, United States
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Bongiolatti S, Mazzoni F, Salimbene O, Caliman E, Ammatuna C, Comin CE, Antonuzzo L, Voltolini L. Induction Chemotherapy Followed by Pleurectomy Decortication and Hyperthermic Intraoperative Chemotherapy (HITHOC) for Early-Stage Epitheliod Malignant Pleural Mesothelioma-A Prospective Report. J Clin Med 2021; 10:jcm10235542. [PMID: 34884251 PMCID: PMC8658521 DOI: 10.3390/jcm10235542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive disease with poor prognosis and the current treatment for early-stage MPM is based on a multimodality therapy regimen involving platinum-based chemotherapy preceding or following surgery. To enhance the cytoreductive role of surgery, some peri- or intra-operative intracavitary treatments have been developed, such as hyperthermic chemotherapy, but long-term results are weak. The aim of this study was to report the post-operative results and mid-term outcomes of our multimodal intention-to-treat pathway, including induction chemotherapy, followed by surgery and Hyperthermic Intraoperative THOracic Chemotherapy (HITHOC) in the treatment of early-stage epithelioid MPM. Since 2017, stage I or II epithelioid MPM patients have been inserted in a surgery-based multimodal approach comprising platinum-based induction chemotherapy, followed by pleurectomy and decortication (P/D) and HITHOC with cisplatin. The Kaplan–Meier method was used to estimate overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS). During the study period, n = 65 patients affected by MPM were evaluated by our institutional Multidisciplinary Tumour Board; n = 12 patients with stage I-II who had no progression after induction chemotherapy underwent P/D and HITHOC. Post-operative mortality was 0, and complications developed in n = 7 (58.3%) patients. The median estimated OS was 31 months with a 1-year and 3-year OS of 100% and 55%, respectively. The median PFS was 26 months with 92% of a 1-year PFS, whereas DFS was 19 months with a 1-year DFS rate of 83%. The multimodal treatment of early-stage epithelioid MPM, including induction chemotherapy followed by P/D and HITHOC, was well tolerated and feasible with promising mid-term oncological results.
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Affiliation(s)
- Stefano Bongiolatti
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy; (O.S.); (L.V.)
- Correspondence: ; Tel.: +39-(55)-7946807; Fax: +39-55-7949557
| | - Francesca Mazzoni
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (F.M.); (E.C.); (L.A.)
| | - Ottavia Salimbene
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy; (O.S.); (L.V.)
| | - Enrico Caliman
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (F.M.); (E.C.); (L.A.)
| | - Carlo Ammatuna
- Department of Experimental and Clinical Medicine, Section of Surgery, Histopathology and Molecular Pathology, University of Florence, 50134 Florence, Italy; (C.A.); (C.E.C.)
| | - Camilla E. Comin
- Department of Experimental and Clinical Medicine, Section of Surgery, Histopathology and Molecular Pathology, University of Florence, 50134 Florence, Italy; (C.A.); (C.E.C.)
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (F.M.); (E.C.); (L.A.)
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy; (O.S.); (L.V.)
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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13
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Lapidot M, Mazzola E, Freyaldenhoven S, De León LE, Jaklitsch MT, Bueno R. Postoperative empyema after pleurectomy decortication for malignant pleural mesothelioma. Ann Thorac Surg 2021; 114:1214-1219. [PMID: 34619137 DOI: 10.1016/j.athoracsur.2021.08.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/11/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative empyema following pleurectomy decortication (PDC) for malignant pleural mesothelioma (MPM) is a serious complication that necessitates prolonged hospitalization. The aim of this study was to determine the incidence, risk factors and prognosis in patients who develop postoperative empyema following PDC. METHODS The background, type of PDC, neo-adjuvant treatment, date of empyema, pleural fluid cultures, post empyema treatment and prognosis from a series of consecutive 355 patients treated over 9 years at a single high-volume center were investigated. Fisher's exact test, Kaplan Meier estimators and log rank test were used to identify significant risk factors for postoperative empyema and compare the overall survival. RESULTS 355 patients underwent PDC for MPM in a 9-year period. There were 263 males and median age at surgery was 69. Neoadjuvant therapy was given to 87 and 282 received intraoperative heated chemotherapy (IOHC). During the study 24 patients (6.8%) developed empyema. The length of stay (LOS) of patients who developed postoperative empyema was significantly longer. Median survival for patients who developed postoperative empyema was 11.7 months and 21.3 months for patients without empyema (HR-1.78, p=0.009). Postoperative empyema was associated with male sex, prolonged air leak and use of prosthetic mesh. CONCLUSIONS Postoperative empyema following PDC is associated with prolonged length of stay and higher mortality. The rates of this serious postoperative complication might decrease by developing better strategies to avoid prolonged air leak after PDC.
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Affiliation(s)
- Moshe Lapidot
- Brigham & Women's Hospital, The International Mesothelioma Program, Harvard Medical School Boston, MA.
| | - Emanuele Mazzola
- Dana Farber Cancer Institute, T.H Chan School of Public Health Boston, Harvard Medical School Boston, MA
| | - Samuel Freyaldenhoven
- Brigham & Women's Hospital, The International Mesothelioma Program, Harvard Medical School Boston, MA
| | - Luis E De León
- Brigham & Women's Hospital, The International Mesothelioma Program, Harvard Medical School Boston, MA
| | - Michael T Jaklitsch
- Brigham & Women's Hospital, The International Mesothelioma Program, Harvard Medical School Boston, MA
| | - Raphael Bueno
- Brigham & Women's Hospital, The International Mesothelioma Program, Harvard Medical School Boston, MA
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14
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Iyoda A, Azuma Y, Sakai T, Koezuka S, Otsuka H, Tochigi N, Isobe K, Sano A. Intraoperative argon-plasma coagulation treatment for patients with malignant pleural mesothelioma. Mol Clin Oncol 2021; 15:188. [PMID: 34349988 PMCID: PMC8327076 DOI: 10.3892/mco.2021.2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/01/2021] [Indexed: 12/02/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is often associated with asbestos exposure and carries an extremely poor prognosis. The present study assessed the effectiveness of argon plasma coagulation (APC) treatment in patients with MPM who underwent radical pleural decortication (PD). The clinical data from 11 patients who underwent radical PD treated with APC at Toho University Omori Medical Center from July 2015 to March 2020 were retrospectively analyzed. Clinical features, local recurrence, and clinical prognoses were evaluated. The median overall survival was 18.5 months, and the 1- and 2-year overall survival rates were 71.6 and 43.0%, respectively. One patient survived 5 years but had recurrent tumors. The median disease-free survival was 11.1 months. The 1- and 2-year disease-free survival rates were 49.9 and 12.5%, respectively. Three patients had no recurrences, two of whom were followed continuously (39.6 and 10.2 months). The present study revealed that APC treatment for MPM might be associated with good survival and prognosis. APC as an additional intraoperative treatment for patients with MPM may be further investigated with larger multi-center clinical trials to support its efficacy.
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Affiliation(s)
- Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Yoko Azuma
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Takashi Sakai
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Kazutoshi Isobe
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
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15
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Nakamura A, Hashimoto M, Matsumoto S, Kondo N, Kijima T, Hasegawa S. Outcomes of Conversion to Extrapleural Pneumonectomy From Pleurectomy/Decortication for Malignant Pleural Mesothelioma. Semin Thorac Cardiovasc Surg 2021; 33:873-881. [PMID: 33609685 DOI: 10.1053/j.semtcvs.2021.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
In recent years, there has been a shift from extrapleural pneumonectomy (EPP) toward pleurectomy/decortication (P/D) as the preferred surgical technique. However, we occasionally encounter difficult cases wherein visceral pleurectomy requires conversion to EPP from P/D. We sought to clarify the preoperative risk factors and clinical outcomes associated with conversion to EPP. We compared and analyzed conversion to EPP and P/D between September 2012 and December 2019. Conversion to EPP was decided in case of diffuse tumor invasion to the pulmonary parenchyma or due to failure of decortication. Univariable regression analysis was performed to determine the association of preoperative variables with conversion to EPP. Survival was analyzed by the Kaplan-Meier method and log-rank test. Of the 181 patients who underwent intended P/D, 145 (80.1%) patients underwent P/D and 18 (9.9%) patients underwent conversion to EPP. The sum of 3-level pleural thickness (P < 0.001), maximum of 3-level pleural thickness (P = 0.006), and clinical T stage (P < 0.001) demonstrated association with conversion to EPP. Overall survival and progression-free survival were significantly worse in the conversion to EPP group (median overall survival, 29.2 months vs 57.0 months [P = 0.008]; median progression-free survival, 15.3 months vs 23.2 months [P = 0.005]. Our data show that approximately 1 of every 10 patients with P/D intention converted to EPP. Preoperative pleural thickness and clinical T stage may be risk factors associated with conversion to EPP. The survival rate of conversion to EPP was worse than that of P/D.
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Affiliation(s)
- Akifumi Nakamura
- Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
| | - Masaki Hashimoto
- Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Seiji Matsumoto
- Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Nobuyuki Kondo
- Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Takashi Kijima
- Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Seiki Hasegawa
- Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
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16
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Kantor T, Wakeam E. Landmark Trials in the Surgical Management of Mesothelioma. Ann Surg Oncol 2021; 28:2037-2047. [PMID: 33521898 DOI: 10.1245/s10434-021-09589-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022]
Abstract
The treatment of mesothelioma has evolved slowly over the last 20 years. While surgery as a standalone treatment has fallen out of favor, the importance of multimodality treatment consisting of combinations of chemotherapy, radiotherapy, and surgery have become more common in operable, fit patients. In this review, we discuss trials in surgery, chemotherapy, and radiation that have shaped contemporary multimodality treatment of this difficult malignancy, and we touch on the new and emerging immunotherapeutic and targeted agents that may change the future treatment of this disease. We also review the multimodality treatment regimens, with particular attention to trimodality therapy and neoadjuvant hemithoracic radiation strategies.
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Affiliation(s)
- Taylor Kantor
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Elliot Wakeam
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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17
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Katz SI, Roshkovan L, Berger I, Friedberg JS, Alley EW, Simone CB, Haas AR, Cengel KA, Sterman DH, Albelda SM. Serum soluble mesothelin-related protein (SMRP) and fibulin-3 levels correlate with baseline malignant pleural mesothelioma (MPM) tumor volumes but are not useful as biomarkers of response in an immunotherapy trial. Lung Cancer 2021; 154:5-12. [PMID: 33561782 DOI: 10.1016/j.lungcan.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/26/2020] [Accepted: 01/10/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Soluble mesothelin-related protein (SMRP) and fibulin-3 serum levels may serve as diagnostic and prognostic biomarkers of malignant pleural mesothelioma (MPM). Here, we evaluate these markers for correlation to tumor volume, prognosis and response assessment in a clinical trial of immunogene therapy in combination with chemotherapy. MATERIALS AND METHODS Serial serum levels of SMRP and fibulin-3 were measured in adult patients with biopsy-proven MPM enrolled in two prospective clinical trials. Pre-therapy computed tomography (CT) measurements of tumor burden were calculated and correlated with pre-therapy serum SMRP and fibulin-3 levels in these two trials. Serological data were also correlated with radiological assessment of response using Modified RECIST criteria over the first 6 months of intrapleural delivery of adenovirus-IFN alpha (Ad.IFN-α) combined with chemotherapy. RESULTS A cohort of 58 patients who enrolled in either a photodynamic therapy trial or immunotherapy clinical trial had available imaging and SMRP serological data for analysis of whom 45 patients had serological fibulin-3 data. The cohort mean total tumor volume was 387 cm3 (STD 561 cm3). Serum SMRP was detectable in 57 of 58 patients (mean 3.8 nM, STD 6.0). Serum fibulin-3 was detected in 44 of 45 patients (mean 23 ng/mL, STD 14). At pre-therapy baseline in these two trials, there was a strong correlation between tumor volume and serum SMRP levels (r = 0.61, p < 0.001), and a moderate correlation between tumor volume and serum fibulin-3 levels (r = 0.36, p = 0.014). Twenty-eight patients in the immunotherapy trial had longitudinal serologic and radiographic data. Fold-changes in SMRP and fibulin-3 did not show significant correlations with modified RECIST measurements. CONCLUSIONS Although our data show correlations of SMRP and fibulin-3 with initial tumor volumes as measured by CT scanning, the use of SMRP and fibulin-3 as serological biomarkers in the immunotherapy trial were not useful in following tumor response longitudinally.
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Affiliation(s)
- Sharyn I Katz
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - Leonid Roshkovan
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Ian Berger
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Joseph S Friedberg
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Evan W Alley
- Department of Hematology and Medical Oncology, Cleveland Clinic Florida, Weston, FL, United States
| | | | - Andrew R Haas
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Daniel H Sterman
- Division of Pulmonary, Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Steven M Albelda
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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18
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Groth SS, Ripley RT. Commentary: Cisplatin-induced nephrotoxicity following cytoreductive surgery and heated intraoperative chemotherapy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2020; 161:1519-1520. [PMID: 32771233 DOI: 10.1016/j.jtcvs.2020.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Shawn S Groth
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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19
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Kim MM, Zhu TC, Ong YH, Finlay JC, Dimofte A, Singhal S, Glatstein E, Cengel KA. Infrared navigation system for light dosimetry during pleural photodynamic therapy. Phys Med Biol 2020; 65:075006. [PMID: 32053799 DOI: 10.1088/1361-6560/ab7632] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Pleural photodynamic therapy (PDT) is performed intraoperatively for the treatment of microscopic disease in patients with malignant pleural mesothelioma. Accurate delivery of light dose is critical to PDT efficiency. As a standard of care, light fluence is delivered to the prescribed fluence using eight isotropic detectors in pre-determined discrete locations inside the pleural cavity that is filled with a dilute Intralipid solution. An optical infrared (IR) navigation system was used to monitor reflective passive markers on a modified and improved treatment delivery wand to track the position of the light source within the treatment cavity during light delivery. This information was used to calculate the light dose, incorporating a constant scattered light dose and using a dual correction method. Calculation methods were extensively compared for eight detector locations and seven patient case studies. The light fluence uniformity was also quantified by representing the unraveled three-dimensional geometry on a two-dimensional plane. Calculated light fluence at the end of treatment delivery was compared to measured values from isotropic detectors. Using a constant scattered dose for all detector locations along with a dual correction method, the difference between calculated and measured values for each detector was within 15%. Primary light dose alone does not fully account for the light delivered inside the cavity. This is useful in determining the light dose delivered to areas of the pleural cavity between detector locations, and can serve to improve treatment delivery with implementation in real-time in the surgical setting. We concluded that the standard deviation of light fluence uniformity for this method of pleural PDT is 10%.
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Affiliation(s)
- Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
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20
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Dupre PJ, Ong YH, Friedberg J, Singhal S, Carter S, Simone CB, Finlay JC, Zhu TC, Cengel KA, Busch TM. Light Fluence Rate and Tissue Oxygenation (S t O 2 ) Distributions Within the Thoracic Cavity of Patients Receiving Intraoperative Photodynamic Therapy for Malignant Pleural Mesothelioma. Photochem Photobiol 2020; 96:417-425. [PMID: 32048732 DOI: 10.1111/php.13224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/29/2019] [Indexed: 01/22/2023]
Abstract
The distributions of light and tissue oxygenation (St O2 ) within the chest cavity were determined for 15 subjects undergoing macroscopic complete resection followed by intraoperative photodynamic therapy (PDT) as part of a clinical trial for the treatment of malignant pleural mesothelioma (MPM). Over the course of light delivery, detectors at each of eight different sites recorded exposure to variable fluence rate. Nevertheless, the treatment-averaged fluence rate was similar among sites, ranging from a median of 40-61 mW cm-2 during periods of light exposure to a detector. St O2 at each tissue site varied by subject, but posterior mediastinum and posterior sulcus were the most consistently well oxygenated (median St O2 >90%; interquartile ranges ~85-95%). PDT effect on St O2 was characterized as the St O2 ratio (post-PDT St O2 /pre-PDT St O2 ). High St O2 pre-PDT was significantly associated with oxygen depletion (St O2 ratio < 1), although the extent of oxygen depletion was mild (median St O2 ratio of 0.8). Overall, PDT of the thoracic cavity resulted in moderate treatment-averaged fluence rate that was consistent among treated tissue sites, despite instantaneous exposure to high fluence rate. Mild oxygen depletion after PDT was experienced at tissue sites with high pre-PDT St O2 , which may suggest the presence of a treatment effect.
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Affiliation(s)
- Pamela J Dupre
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Yi Hong Ong
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Joseph Friedberg
- Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Sunil Singhal
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Shirron Carter
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, United States
| | - Jarod C Finlay
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Timothy C Zhu
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Keith A Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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21
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Kim MM, Darafsheh A. Light Sources and Dosimetry Techniques for Photodynamic Therapy. Photochem Photobiol 2020; 96:280-294. [PMID: 32003006 DOI: 10.1111/php.13219] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/29/2019] [Indexed: 12/19/2022]
Abstract
Effective treatment delivery in photodynamic therapy (PDT) requires coordination of the light source, the photosensitizer, and the delivery device appropriate to the target tissue. Lasers, light-emitting diodes (LEDs), and lamps are the main types of light sources utilized for PDT applications. The choice of light source depends on the target location, photosensitizer used, and light dose to be delivered. Geometry of minimally accessible areas also plays a role in deciding light applicator type. Typically, optical fiber-based devices are used to deliver the treatment light close to the target. The optical properties of tissue also affect the distribution of the treatment light. Treatment light undergoes scattering and absorption in tissue. Most tissue will scatter light, but highly pigmented areas will absorb light, especially at short wavelengths. This review will summarize the basic physics of light sources, and describe methods for determining the dose delivered to the patient.
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Affiliation(s)
- Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Arash Darafsheh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
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22
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Trempolec N, Doix B, Degavre C, Brusa D, Bouzin C, Riant O, Feron O. Photodynamic Therapy-Based Dendritic Cell Vaccination Suited to Treat Peritoneal Mesothelioma. Cancers (Basel) 2020; 12:cancers12030545. [PMID: 32120810 PMCID: PMC7139796 DOI: 10.3390/cancers12030545] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023] Open
Abstract
The potential of dendritic cell (DC)-based immunotherapy to treat cancer is, nowadays, well documented. Still, the clinical success of immune checkpoint inhibitors has dampened the interest in anticancer DC vaccination. For highly life-threatening tumors that are regarded as nonimmunogenic, such as mesothelioma, however, T helper 1 immunity-biased DC-based immunotherapy could still represent an attractive strategy. In this study, we took advantage of photodynamic therapy (PDT) to induce immunogenic cell death to generate mesothelioma cell lysates for DC priming and evaluated such a vaccine to treat peritoneal mesothelioma. We found that the white light in vitro activation of the photosensitizer OR141 led to mesothelioma cell death, together with the release of bona fide danger signals that promote DC maturation. The administration of a PDT-based DC vaccine to mice bearing peritoneal mesothelioma led to highly significant survival when compared with sham or control animals treated with anti-CTLA4 antibodies. This was further supported by a strong CD8+ and CD4+ T cell response, characterized by an increased proliferation, cytotoxic activities and the expression of activation markers, including interferon gamma (IFNγ). Moreover, the PDT-based DC vaccine led to a significant increase in IFNγ+ T cells infiltered within mesothelioma, as determined by flow cytometry and immunohistochemistry. Finally, in vivo tracking of intraperitoneally administered DCs led us to document rapid chemotaxis towards tumor-occupied lymphatics (vs. lipopolysaccharide (LPS)-treated DC). DCs pulsed with PDT-killed mesothelioma cells also exhibited a significant increase in CCR7 receptors, together with an intrinsic capacity to migrate towards the lymph nodes. Altogether, these results indicate that PDT-based DC vaccination is particularly suited to induce a potent immune response against peritoneal mesothelioma.
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Affiliation(s)
- Natalia Trempolec
- Pole of Pharmacology and Therapeutics (FATH), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, 1200 Brussels, Belgium; (N.T.); (B.D.); (C.D.)
| | - Bastien Doix
- Pole of Pharmacology and Therapeutics (FATH), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, 1200 Brussels, Belgium; (N.T.); (B.D.); (C.D.)
| | - Charline Degavre
- Pole of Pharmacology and Therapeutics (FATH), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, 1200 Brussels, Belgium; (N.T.); (B.D.); (C.D.)
| | - Davide Brusa
- Institut de Recherche Expérimentale et Clinique (IREC) Flow Cytometry Platform, UCLouvain, 1200 Brussels, Belgium;
| | - Caroline Bouzin
- Institut de Recherche Expérimentale et Clinique (IREC) 2IP, UCLouvain, 1200 Brussels, Belgium;
| | - Olivier Riant
- Institute of Condensed Matter and Nanosciences (IMCN), Molecular Chemistry, Materials and Catalysis, UCLouvain, 1348 Louvain-la-Neuve, Belgium;
| | - Olivier Feron
- Pole of Pharmacology and Therapeutics (FATH), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, 1200 Brussels, Belgium; (N.T.); (B.D.); (C.D.)
- Correspondence: ; Tel.: +32-2-7645264; Fax: +32-2-7645269
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23
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Ong YH, Dimofte A, Kim MM, Finlay JC, Sheng T, Singhal S, Cengel KA, Yodh AG, Busch TM, Zhu TC. Reactive Oxygen Species Explicit Dosimetry for Photofrin-mediated Pleural Photodynamic Therapy. Photochem Photobiol 2019; 96:340-348. [PMID: 31729774 DOI: 10.1111/php.13176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/18/2019] [Indexed: 01/10/2023]
Abstract
Explicit dosimetry of treatment light fluence and implicit dosimetry of photosensitizer photobleaching are commonly used methods to guide dose delivery during clinical PDT. Tissue oxygen, however, is not routinely monitored intraoperatively even though it is one of the three major components of treatment. Quantitative information about in vivo tissue oxygenation during PDT is desirable, because it enables reactive oxygen species explicit dosimetry (ROSED) for prediction of treatment outcome based on PDT-induced changes in tumor oxygen level. Here, we demonstrate ROSED in a clinical setting, Photofrin-mediated pleural photodynamic therapy, by utilizing tumor blood flow information measured by diffuse correlation spectroscopy (DCS). A DCS contact probe was sutured to the pleural cavity wall after surgical resection of pleural mesothelioma tumor to monitor tissue blood flow (blood flow index) during intraoperative PDT treatment. Isotropic detectors were used to measure treatment light fluence and photosensitizer concentration. Blood-flow-derived tumor oxygen concentration, estimated by applying a preclinically determined conversion factor of 1.5 × 109 μMs cm-2 to the blood flow index, was used in the ROSED model to calculate the total reacted reactive oxygen species [ROS]rx. Seven patients and 12 different pleural sites were assessed and large inter- and intrapatient heterogeneities in [ROS]rx were observed although an identical light dose of 60 J cm-2 was prescribed to all patients.
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Affiliation(s)
- Yi Hong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.,Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Andreaa Dimofte
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Jarod C Finlay
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Tianqi Sheng
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Sunil Singhal
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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24
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Yan L, Luo L, Amirshaghaghi A, Miller J, Meng C, You T, Busch TM, Tsourkas A, Cheng Z. Dextran-Benzoporphyrin Derivative (BPD) Coated Superparamagnetic Iron Oxide Nanoparticle (SPION) Micelles for T 2-Weighted Magnetic Resonance Imaging and Photodynamic Therapy. Bioconjug Chem 2019; 30:2974-2981. [PMID: 31661959 DOI: 10.1021/acs.bioconjchem.9b00676] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Photodynamic therapy (PDT) has attracted extensive attention in recent years as a noninvasive and locally targeted cancer treatment approach. Nanoparticles have been used to improve the solubility and pharmacokinetics of the photosensitizers required for PDT; however, nanoparticles also suffer from many shortcomings including uncontrolled drug release and low tumor accumulation. Herein, we describe a novel biodegradable nanoplatform for the delivery of the clinically used PDT photosensitizer benzoporphyrin derivative monoacid ring A (BPD-MA) to tumors. Specifically, the hydrophobic photosensitizer BPD was covalently conjugated to the amine groups of a dextran-b-oligo (amidoamine) (dOA) dendron copolymer, forming amphiphilic dextran-BPD conjugates that can self-assemble into nanometer-sized micelles in water. To impart additional imaging capabilities to these micelles, superparamagnetic iron oxide nanoparticles (SPIONs) were encapsulated within the hydrophobic core to serve as a magnetic resonance imaging (MRI) contrast agent. The use of a photosensitizer as a hydrophobic building block enabled facile and reproducible synthesis and high drug loading capacity (∼30%, w/w). Furthermore, covalent conjugation of BPD to dextran prevents the premature release of drug during systemic circulation. In vivo studies show that the intravenous administration of dextran-BPD coated SPION nanoparticles results in significant MR contrast enhancement within tumors 24 h postinjection and PDT led to a significant reduction in the tumor growth rate.
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Affiliation(s)
- Lesan Yan
- Department of Bioengineering, School of Engineering and Applied Sciences , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
| | - Lijun Luo
- Department of Bioengineering, School of Engineering and Applied Sciences , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States.,School of Agricultural Equipment Engineering , Jiangsu University , Zhenjiang , Jiangsu 212013 , China
| | - Ahmad Amirshaghaghi
- Department of Bioengineering, School of Engineering and Applied Sciences , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
| | - Joann Miller
- Department of Radiation Oncology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
| | - Cathy Meng
- Department of Bioengineering, School of Engineering , University of California Berkeley , Berkeley , California 94720 , United States
| | - Tianyan You
- School of Agricultural Equipment Engineering , Jiangsu University , Zhenjiang , Jiangsu 212013 , China
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
| | - Andrew Tsourkas
- Department of Bioengineering, School of Engineering and Applied Sciences , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
| | - Zhiliang Cheng
- Department of Bioengineering, School of Engineering and Applied Sciences , University of Pennsylvania , Philadelphia , Pennsylvania 19104 , United States
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25
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Zhu TC, Ong Y, Kim MM, Liang X, Finlay JC, Dimofte A, Simone CB, Friedberg JS, Busch TM, Glatstein E, Cengel KA. Evaluation of Light Fluence Distribution Using an IR Navigation System for HPPH-mediated Pleural Photodynamic Therapy (pPDT). Photochem Photobiol 2019; 96:310-319. [PMID: 31556122 DOI: 10.1111/php.13166] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 12/29/2022]
Abstract
Uniform light fluence distribution for patients undergoing photodynamic therapy (PDT) is critical to ensure predictable PDT outcomes. However, current practice when delivering intrapleural PDT uses a point source to deliver light that is monitored by seven isotropic detectors placed within the pleural cavity to assess its uniformity. We have developed a real-time infrared (IR) tracking camera to follow the movement of the light point source and the surface contour of the treatment area. The calculated light fluence rates were matched with isotropic detectors using a two-correction factor method and an empirical model that includes both direct and scattered light components. Our clinical trial demonstrated that we can successfully implement the IR navigation system in 75% (15/20) of the patients. Data were successfully analyzed in 80% (12/15) patients because detector locations were not available for three patients. We conclude that it is feasible to use an IR camera-based system to track the motion of the light source during PDT and demonstrate its use to quantify the uniformity of light distribution, which deviated by a standard deviation of 18% from the prescribed light dose. The navigation system will fail when insufficient percentage of light source positions is obtained (<30%) during PDT.
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Affiliation(s)
- Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Yihong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Xing Liang
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Jarod C Finlay
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Andreea Dimofte
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Eli Glatstein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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26
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Berger I, Cengel KA, Simone CB, Alley EW, Roshkovan L, Haas AR, Patel AM, Khalid U, Culligan MJ, McNulty S, Singhal S, Friedberg JS, Katz SI. Lymphangitic carcinomatosis: A common radiographic manifestation of local failure following extended pleurectomy/decortication in patients with malignant pleural mesothelioma. Lung Cancer 2019; 132:94-98. [PMID: 31097101 DOI: 10.1016/j.lungcan.2019.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The lymphangitic carcinomatosis (LC) pattern of metastatic malignancy is associated with a poor prognosis but is currently not well defined in malignant pleural mesothelioma (MPM). Here, we report the incidence and prognostic significance of the radiographic development of LC in MPM following extended pleurectomy/decortication (EPD). METHODS Consecutive patients with biopsy-proven MPM undergoing EPD with intraoperative photodynamic therapy (PDT) at our institution from 2008 to 2014 were included in this retrospective study. Patients without available post-surgical clinical or imaging data for direct review were excluded. CT images were reviewed by an experienced, board-certified thoracic radiologist and confirmed by consensus review. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan Meier methodology. Hazard ratios were compared with a cox proportional hazard model. RESULTS 44 patients underwent EPD with PDT during the study period and had available clinical and imaging data. During the follow-up period (median 34 months), 17 patients (39%) developed LC at a median of 10 months after surgery (IQR 5-21 months). 16 of the 17 patients who developed LC (94%) died during the follow-up period, compared to 17 of the 27 who did not develop LC (63%). OS for the LC versus non-LC group was 53% versus 93% at 1 year and 18% versus 67% at 3 years. LC was significantly associated with a lower OS (HR 4.07; 95% confidence interval 1.44-11.48; p = 0.008). PFS for the LC group versus non-LC group was 8 months (IQR 5-9 months) compared to 17 months (IQR 11-24 months) (p < 0.001). CONCLUSION LC is a common form of failure in MPM following EPD and is associated with a poor prognosis. Thus, further studies are warranted to determine if any evidence of preoperative LC should be an absolute contraindication to EPD and may warrant an EPP or no surgery at all.
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Affiliation(s)
- Ian Berger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Keith A Cengel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Charles B Simone
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Evan W Alley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Leonid Roshkovan
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Andrew R Haas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Akash M Patel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Urooj Khalid
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | | | - Sally McNulty
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Sunil Singhal
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | | | - Sharyn I Katz
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
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27
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Spring BQ, Lang RT, Kercher EM, Rizvi I, Wenham RM, Conejo-Garcia JR, Hasan T, Gatenby RA, Enderling H. Illuminating the Numbers: Integrating Mathematical Models to Optimize Photomedicine Dosimetry and Combination Therapies. FRONTIERS IN PHYSICS 2019; 7:46. [PMID: 31123672 PMCID: PMC6529192 DOI: 10.3389/fphy.2019.00046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cancer photomedicine offers unique mechanisms for inducing local tumor damage with the potential to stimulate local and systemic anti-tumor immunity. Optically-active nanomedicine offers these features as well as spatiotemporal control of tumor-focused drug release to realize synergistic combination therapies. Achieving quantitative dosimetry is a major challenge, and dosimetry is fundamental to photomedicine for personalizing and tailoring therapeutic regimens to specific patients and anatomical locations. The challenge of dosimetry is perhaps greater for photomedicine than many standard therapies given the complexity of light delivery and light-tissue interactions as well as the resulting photochemistry responsible for tumor damage and drug-release, in addition to the usual intricacies of therapeutic agent delivery. An emerging multidisciplinary approach in oncology utilizes mathematical and computational models to iteratively and quantitively analyze complex dosimetry, and biological response parameters. These models are parameterized by preclinical and clinical observations and then tested against previously unseen data. Such calibrated and validated models can be deployed to simulate treatment doses, protocols, and combinations that have not yet been experimentally or clinically evaluated and can provide testable optimal treatment outcomes in a practical workflow. Here, we foresee the utility of these computational approaches to guide adaptive therapy, and how mathematical models might be further developed and integrated as a novel methodology to guide precision photomedicine.
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Affiliation(s)
- Bryan Q. Spring
- Translational Biophotonics Cluster, Northeastern University, Boston, MA, United States
- Department of Physics, Northeastern University, Boston, MA, United States
- Department of Bioengineering, Northeastern University, Boston, MA, United States
| | - Ryan T. Lang
- Translational Biophotonics Cluster, Northeastern University, Boston, MA, United States
- Department of Physics, Northeastern University, Boston, MA, United States
| | - Eric M. Kercher
- Translational Biophotonics Cluster, Northeastern University, Boston, MA, United States
- Department of Physics, Northeastern University, Boston, MA, United States
| | - Imran Rizvi
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Robert M. Wenham
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - José R. Conejo-Garcia
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Robert A. Gatenby
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Heiko Enderling
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
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28
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Beeson KW, Parilov E, Potasek M, Kim MM, Zhu TC. Validation of combined Monte Carlo and photokinetic simulations for the outcome correlation analysis of benzoporphyrin derivative-mediated photodynamic therapy on mice. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-9. [PMID: 30873764 PMCID: PMC6416474 DOI: 10.1117/1.jbo.24.3.035006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/05/2019] [Indexed: 05/16/2023]
Abstract
We compare previously reported benzoporphyrin derivative (BPD)-mediated photodynamic therapy (PDT) results for reactive singlet oxygen concentration (also called singlet oxygen dose) on mice with simulations using a computational device, Dosie™, that calculates light transport and photokinetics for PDT in near real-time. The two sets of results are consistent and validate the use of the device in PDT treatment planning to predict BPD-mediated PDT outcomes in mice animal studies based on singlet oxygen dose, which showed a much better correlation with the cure index than the conventional light dose.
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Affiliation(s)
- Karl W. Beeson
- Simphotek, Inc., Newark, New Jersey, United States
- Address all correspondence to Karl W. Beeson, E-mail:
| | | | - Mary Potasek
- Simphotek, Inc., Newark, New Jersey, United States
| | - Michele M. Kim
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
| | - Timothy C. Zhu
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, Pennsylvania, United States
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29
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Computational study of necrotic areas in rat liver tissue treated with photodynamic therapy. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2019; 192:40-48. [DOI: 10.1016/j.jphotobiol.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/07/2019] [Accepted: 01/15/2019] [Indexed: 12/27/2022]
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30
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Cramer G, Shin M, Hagan S, Katz SI, Simone CB, Busch TM, Cengel KA. Modeling Epidermal Growth Factor Inhibitor-mediated Enhancement of Photodynamic Therapy Efficacy Using 3D Mesothelioma Cell Culture. Photochem Photobiol 2019; 95:397-405. [PMID: 30499112 DOI: 10.1111/php.13067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/19/2018] [Indexed: 12/29/2022]
Abstract
We have demonstrated that lung-sparing surgery with intraoperative photodynamic therapy (PDT) achieves remarkably extended survival for patients with malignant pleural mesothelioma (MPM). Nevertheless, most patients treated using this approach experience local recurrence, so it is essential to identify ways to enhance tumor response. We previously reported that PDT transiently activates EGFR/STAT3 in lung and ovarian cancer cells and inhibiting EGFR via erlotinib can increase PDT sensitivity. Additionally, we have seen higher EGFR expression associating with worse outcomes after Photofrin-mediated PDT for MPM, and the extensive desmoplastic reaction associated with MPM influences tumor phenotype and therapeutic response. Since extracellular matrix (ECM) proteins accrued during stroma development can alter EGF signaling within tumors, we have characterized novel 3D models of MPM to determine their response to erlotinib combined with Photofrin-PDT. Our MPM cell lines formed a range of acinar phenotypes when grown on ECM gels, recapitulating the locally invasive phenotype of MPM in pleura and endothoracic fascia. Using these models, we confirmed that EGFR inhibition increases PDT cytotoxicity. Together with emerging evidence that EGFR inhibition may improve survival of lung cancer patients through immunologic and direct cell killing mechanisms, these results suggest erlotinib-enhanced PDT may significantly improve outcomes for MPM patients.
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Affiliation(s)
- Gwendolyn Cramer
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Shin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sarah Hagan
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sharyn I Katz
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Keith A Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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31
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Hasegawa S, Kondo N, Matsumoto S, Takuwa T, Hashimoto M, Kuroda A, Nakamichi T, Kamikonya N, Tsujimura T, Nakano T. Surgical Risk and Survival Associated With Less Invasive Surgery for Malignant Pleural Mesothelioma. Semin Thorac Cardiovasc Surg 2019; 31:301-309. [DOI: 10.1053/j.semtcvs.2019.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 11/11/2022]
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32
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Rice SR, Li YR, Busch TM, Kim MM, McNulty S, Dimofte A, Zhu TC, Cengel KA, Simone CB. A Novel Prospective Study Assessing the Combination of Photodynamic Therapy and Proton Radiation Therapy: Safety and Outcomes When Treating Malignant Pleural Mesothelioma. Photochem Photobiol 2019; 95:411-418. [PMID: 30485442 PMCID: PMC6778401 DOI: 10.1111/php.13065] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022]
Abstract
Malignant pleural mesothelioma remains difficult to treat, with high failure rates despite optimal therapy. We present a novel prospective trial combining proton therapy (PT) and photodynamic therapy (PDT) and the largest-ever mesothelioma PT experience (n = 10). PDT photosensitizers included porfimer sodium (2 mg·kg-1 ; 24 h drug-light interval) or 2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-a (HPPH) (4 mg·m-2 ;48 h) with wavelengths of 630 nm to 60J·cm-2 and 665 nm to 15-45J·cm-2 , respectively. With a median age of 69 years, patients were predominantly male (90%) with epithelioid histology (100%) and stage III-IV disease (100%). PT was delivered to a median of 55.0 CGE/1.8-2.0 CGE (range 50-75 CGE) adjuvantly (n = 8) or as salvage therapy (n = 2) following extended pleurectomy/decortication (ePD)/PDT. Two-year local control was 90%, with distant and regional failure rates of 50% and 30%, respectively. All patients received chemotherapy, and four received immunotherapy. Surgical complications included atrial fibrillation (n = 3), pneumonia (n = 2), and deep vein thrombosis (n = 2). Median survival from PT completion was 19.5 months (30.3 months from diagnosis), and 1- and 2-year survival rates were 58% and 29%. No patient experienced CTCAEv4 grade ≥2 acute or late toxicity. Our prolonged survival in very advanced-stage patients compares favorably to survival for PT without PDT and photon therapy with PDT, suggesting possible spatial or systemic cooperativity and immune effect.
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Affiliation(s)
- Stephanie R. Rice
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Yun R. Li
- Helen Diller Family Comprehensive Cancer Center, Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Theresa M. Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michele M. Kim
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sally McNulty
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrea Dimofte
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Timothy C. Zhu
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Keith A. Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Charles B. Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
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33
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Spring BQ, Kessel D. 3D Culture Models of Malignant Mesothelioma Reveal a Powerful Interplay Between Photodynamic Therapy and Kinase Suppression Offering Hope to Reduce Tumor Recurrence. Photochem Photobiol 2018; 95:462-463. [PMID: 30485439 DOI: 10.1111/php.13059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
In this issue, Cramer et al. introduce 3D culture models of metastatic mesothelioma to investigate basic cancer biology and new combination therapies for combating this complex and lethal disease. The results suggest that erlotinib-enhanced photodynamic therapy could further improve the efficacy of intraoperative light-activation to mop up residual tumor deposits in the clinic following surgical removal of macroscopic mesothelioma metastases.
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Affiliation(s)
- Bryan Q Spring
- Translational Biophotonics Cluster, Northeastern University, Boston, MA.,Department of Physics, Northeastern University, Boston, MA.,Department of Bioengineering, Northeastern University, Boston, MA
| | - David Kessel
- Department of Pharmacology, Wayne State University School of Medicine, Detroit, MI
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34
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Davis RW, Snyder E, Miller J, Carter S, Houser C, Klampatsa A, Albelda SM, Cengel KA, Busch TM. Luminol Chemiluminescence Reports Photodynamic Therapy-Generated Neutrophil Activity In Vivo and Serves as a Biomarker of Therapeutic Efficacy. Photochem Photobiol 2018; 95:430-438. [PMID: 30357853 DOI: 10.1111/php.13040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/03/2018] [Indexed: 01/26/2023]
Abstract
Inflammatory cells, most especially neutrophils, can be a necessary component of the antitumor activity occurring after administration of photodynamic therapy. Generation of neutrophil responses has been suggested to be particularly important in instances when the delivered photodynamic therapy (PDT) dose is insufficient. In these cases, the release of neutrophil granules and engagement of antitumor immunity may play an important role in eliminating residual disease. Herein, we utilize in vivo imaging of luminol chemiluminescence to noninvasively monitor neutrophil activation after PDT administration. Studies were performed in the AB12 murine model of mesothelioma, treated with Photofrin-PDT. Luminol-generated chemiluminescence increased transiently 1 h after PDT, followed by a subsequent decrease at 4 h after PDT. The production of luminol signal was not associated with the influx of Ly6G+ cells, but was related to oxidative burst, as an indicator of neutrophil function. Most importantly, greater levels of luminol chemiluminescence 1 h after PDT were prognostic of a complete response at 90 days after PDT. Taken together, this research supports an important role for early activity by Ly6G+ cells in the generation of long-term PDT responses in mesothelioma, and it points to luminol chemiluminescence as a potentially useful approach for preclinical monitoring of neutrophil activation by PDT.
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Affiliation(s)
- Richard W Davis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emma Snyder
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joann Miller
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shirron Carter
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Cassandra Houser
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Astero Klampatsa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven M Albelda
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Keith A Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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35
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Kato T, Jin CS, Lee D, Ujiie H, Fujino K, Hu HP, Wada H, Wu L, Chen J, Weersink RA, kanno H, Hatanaka Y, Hatanaka KC, Kaga K, Matsui Y, Matsuno Y, De Perrot M, Wilson BC, Zheng G, Yasufuku K. Preclinical investigation of folate receptor-targeted nanoparticles for photodynamic therapy of malignant pleural mesothelioma. Int J Oncol 2018; 53:2034-2046. [PMID: 30226590 PMCID: PMC6192720 DOI: 10.3892/ijo.2018.4555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/01/2018] [Indexed: 11/07/2022] Open
Abstract
Photodynamic therapy (PDT) following lung-sparing extended pleurectomy for malignant pleural mesothelioma (MPM) has been investigated as a potential means to kill residual microscopic cells. High expression levels of folate receptor 1 (FOLR1) have been reported in MPM; therefore, targeting FOLR1 has been considered a novel potential strategy. The present study developed FOLR1‑targeting porphyrin-lipid nanoparticles (folate-porphysomes, FP) for the treatment of PDT. Furthermore, inhibition of activated epidermal growth factor (EGFR)-associated survival pathways enhance PDT efficacy. In the present study, these approaches were combined; FP-based PDT was used together with an EGFR-tyrosine kinase inhibitor (EGFR-TKI). The frequency of FOLR1 and EGFR expression in MPM was analyzed using tissue microarrays. Confocal microscopy and a cell viability assay were performed to confirm the specificity of FOLR1‑targeting cellular uptake and photocytotoxicity in vitro. In vivo fluorescence activation and therapeutic efficacy were subsequently examined. The effects of EGFR-TKI were also assessed in vitro. The in vivo combined antitumor effect of EGFR-TKI and FP-PDT was then evaluated. The results revealed that FOLR1 and EGFR were expressed in 79 and 89% of MPM samples, respectively. In addition, intracellular uptake of FP corresponded well with FOLR1 expression. When MPM cells were incubated with FP and then irradiated at 671 nm, there was significant in vitro cell death, which was inhibited in the presence of free folic acid, thus suggesting the specificity of FPs. FOLR1 targeting resulted in disassembly of the porphysomes and subsequent fluorescence activation in intrathoracic disseminated MPM tumors, as demonstrated by ex vivo tissue imaging. FP-PDT resulted in significant cellular damage and apoptosis in vivo. Furthermore, the combination of pretreatment with EGFR-TKI and FP-PDT induced a marked improvement of treatment responses. In conclusion, FP-based PDT induced selective destruction of MPM cells based on FOLR1 targeting, and pretreatment with EGFR-TKI further enhanced the therapeutic response.
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Affiliation(s)
- Tatsuya Kato
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Cheng s. Jin
- Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, ON M5G 1L5
| | - Daiyoon Lee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Kosuke Fujino
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Hsin-Pei Hu
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Hironobu Wada
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Licun Wu
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Juan Chen
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7
| | - Rober a. Weersink
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, ON M5G 1L5
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Hiromi kanno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido 060-8648, Japan
| | - Yutaka Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido 060-8648, Japan
| | - Kanako c. Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido 060-8648, Japan
| | - Kichizo Kaga
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido 060-8648, Japan
| | - Marc De Perrot
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Brian c. Wilson
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Gang Zheng
- Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, ON M5G 1L5
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
- DLVR Therapeutics Inc. and University Health Network, Toronto, ON M5G 0A3, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
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De Bondt C, Psallidas I, Van Schil PEY, van Meerbeeck JP. Combined modality treatment in mesothelioma: a systemic literature review with treatment recommendations. Transl Lung Cancer Res 2018; 7:562-573. [PMID: 30450295 DOI: 10.21037/tlcr.2018.10.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In spite of recent progress, malignant pleural mesothelioma (MPM) remains synonymous with poor prognosis. A selected minority (<10%) of patients is eligible for a radical treatment with a combination of systemic chemotherapy (CT) and/or surgery and/or radiotherapy (RT), in an effort to maintain locoregional tumor control after achieving a macroscopically complete resection (MCR). However, as of yet there is no standard of care for this so-called multimodality treatment. As its potential gain is still limited (approximately one year added to overall survival), we must balance its efficacy with its cumulative toxicity. Several combined modality treatment trials are currently ongoing using novel techniques in surgery, RT and/or CT in an attempt to reduce the morbidity and mortality associated with older multimodality treatment protocols. Guidelines are following suit and are now including or mentioning this treatment option. In this systematic review, we analyze the available data in order to address the following questions: Is combined modality better than single modality? What is the optimal regimen within each modality? What is the optimal sequence of combined modality?
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Affiliation(s)
- Charlotte De Bondt
- Department Pulmonology and Thoracic Oncology, Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Paul E Y Van Schil
- Department Thoracic and Vascular Surgery, Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Jan P van Meerbeeck
- Department Pulmonology and Thoracic Oncology, Antwerp University and Antwerp University Hospital, Antwerp, Belgium
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Doix B, Bastien E, Rambaud A, Pinto A, Louis C, Grégoire V, Riant O, Feron O. Preclinical Evaluation of White Led-Activated Non-porphyrinic Photosensitizer OR141 in 3D Tumor Spheroids and Mouse Skin Lesions. Front Oncol 2018; 8:393. [PMID: 30298119 PMCID: PMC6160539 DOI: 10.3389/fonc.2018.00393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/31/2018] [Indexed: 01/10/2023] Open
Abstract
Photodynamic therapy (PDT) is used to treat malignancies and precancerous lesions. Near-infrared light delivered by lasers was thought for a while to be the most appropriate option to activate photosensitizers, mostly porphyrins, in the depth of the diseased tissues. More recently, however, several advantages including low cost and reduced adverse effects led to consider light emitting diodes (LED) and even daylight as an alternative to use PDT to treat accessible lesions. In this study we examined the capacity of OR141, a recently identified non-porphyrin photosensitizer (PS), to exert significant cytotoxic effects in various models of skin lesions and tumors upon white light activation. Using different cancer cell lines, we first identified LED lamp as a particularly suited source of light to maximize anti-proliferative effects of OR141. We then documented that OR141 diffusion and light penetration into tumor spheroids both reached thresholds compatible with the induction of cell death deep inside these 3D culture models. We further identified Arlasove as a clinically suitable solvent for OR141 that we documented by using Franz cells to support significant absorption of the PS through human skin. Finally, using topical but also systemic administration, we validated growth inhibitory effects of LED-activated OR141 in mouse skin tumor xenograft and precancerous lesions models. Altogether these results open clinical perspectives for the use of OR141 as an attractive PS to treat superficial skin malignant and non-malignant lesions using affordable LED lamp for photoactivation.
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Affiliation(s)
- Bastien Doix
- Pole of Pharmacology and Therapeutics (FATH), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Estelle Bastien
- Pole of Pharmacology and Therapeutics (FATH), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Alix Rambaud
- Pole of Pharmacology and Therapeutics (FATH), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Adán Pinto
- Pole of Pharmacology and Therapeutics (FATH), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Caroline Louis
- Pole of Pharmacology and Therapeutics (FATH), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Vincent Grégoire
- Pole of Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Olivier Riant
- Institute of Condensed Matter and Nanosciences Molecules, Solids and Reactivity (IMCN/MOST), Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Olivier Feron
- Pole of Pharmacology and Therapeutics (FATH), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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Davis RW, Papasavvas E, Klampatsa A, Putt M, Montaner LJ, Culligan MJ, McNulty S, Friedberg JS, Simone CB, Singhal S, Albelda SM, Cengel KA, Busch TM. A preclinical model to investigate the role of surgically-induced inflammation in tumor responses to intraoperative photodynamic therapy. Lasers Surg Med 2018; 50:440-450. [PMID: 29799130 DOI: 10.1002/lsm.22934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Inflammation is a well-known consequence of surgery. Although surgical debulking of tumor is beneficial to patients, the onset of inflammation in injured tissue may impede the success of adjuvant therapies. One marker for postoperative inflammation is IL-6, which is released as a consequence of surgical injuries. IL-6 is predictive of response to many cancer therapies, and it is linked to various molecular and cellular resistance mechanisms. The purpose of this study was to establish a murine model by which therapeutic responses to photodynamic therapy (PDT) can be studied in the context of surgical inflammation. MATERIALS AND METHODS Murine models with AB12 mesothelioma tumors were treated with either surgical resection or sham surgery with tumor incision but no resection. The timing and extent of IL-6 release in the tumor and/or serum was measured using enzyme-linked immunosorbent assay (ELISA) and compared to that measured in the serum of 27 consecutive, prospectively enrolled patients with malignant pleural mesothelioma (MPM) who underwent macroscopic complete resection (MCR). RESULTS MPM patients showed a significant increase in IL-6 at the time MCR was completed. Similarly, IL-6 increased in the tumor and serum of mice treated with surgical resections. However, investigations that combine resection with another therapy make it necessary to grow tumors for resection to a larger volume than those that receive secondary therapy alone. As the larger size may alter tumor biology independent of the effects of surgical injury, we assessed the tumor incision model. In this model, tumor levels of IL-6 significantly increased after tumor incision. CONCLUSION The tumor incision model induces IL-6 release as is seen in the surgical setting, yet it avoids the limitations of surgical resection models. Potential mechanisms by which surgical induction of inflammation and IL-6 could alter the nature and efficacy of tumor response to PDT are reviewed. These include a wide spectrum of molecular and cellular mechanisms through which surgically-induced IL-6 could change the effectiveness of therapies that are combined with surgery. The tumor incision model can be employed for novel investigations of the effects of surgically-induced, acute inflammation on therapeutic response to PDT (or potentially other therapies). Lasers Surg. Med. 50:440-450, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Richard W Davis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | | | - Astero Klampatsa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Mary Putt
- Department of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Luis J Montaner
- Wistar Institute, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Melissa J Culligan
- Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Sally McNulty
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Joseph S Friedberg
- Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Charles B Simone
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Sunil Singhal
- Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Steven M Albelda
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Keith A Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104
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Marulli G, Breda C, Fontana P, Ratto GB, Leoncini G, Alloisio M, Infante M, Luzzi L, Paladini P, Oliaro A, Ruffini E, Benvenuti MR, Pariscenti G, Spaggiari L, Casiraghi M, Rusca M, Carbognani P, Ampollini L, Facciolo F, Leuzzi G, Mucilli F, Camplese P, Romanello P, Perissinotto E, Rea F. Pleurectomy-decortication in malignant pleural mesothelioma: are different surgical techniques associated with different outcomes? Results from a multicentre study. Eur J Cardiothorac Surg 2018; 52:63-69. [PMID: 28419212 DOI: 10.1093/ejcts/ezx079] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The potential benefit of surgery for malignant pleural mesothelioma (MPM), especially concerning pleurectomy/decortication (P/D), is unclear from the literature. The aim of this study was to evaluate the outcome after multimodality treatment of MPM involving different types of P/D and to analyse the prognostic factors. METHODS We reviewed 314 patients affected by MPM who were operated on in 11 Italian centres from 1 January 2007 to 11 October 2014. RESULTS The characteristics of the population were male/female ratio: 3.7/1, and median age at operation was 67.8 years. The epithelioid histotype was observed in 79.9% of patients; neoadjuvant chemotherapy was given to 57% of patients and Stage III disease was found following a pathological analysis in 62.3% of cases. A total of 162 (51.6%) patients underwent extended P/D (EP/D); 115 (36.6%) patients had P/D and 37 (11.8%) received only a partial pleurectomy. Adjuvant radiotherapy was delivered in 39.2% of patients. Median overall survival time after surgery was 23.0 [95% confidence interval (CI): 19.6-29.1] months. On multivariable (Cox) analysis, pathological Stage III-IV [ P = 0.004, hazard ratio (HR):1.34; 95% CI: 1.09-1.64], EP/D and P/D ( P = 0.006, HR for EP/D: 0.46; 95% CI: 0.29-0.74; HR for P/D: 0.52; 95% CI: 0.31-0.87), left-sided disease ( P = 0.01, HR: 1.52; 95% CI: 1.09-2.12) and pathological status T4 ( P = 0.0003, HR: 1.38; 95% CI: 1.14-1.66) were found to be independent significant predictors of overall survival. CONCLUSIONS Whether the P/D is extended or not, it shows similarly good outcomes in terms of early results and survival rate. In contrast, a partial pleurectomy, which leaves gross tumour behind, has no impact on survival.
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Affiliation(s)
| | - Cristiano Breda
- Thoracic Surgery Unit, ULSS 12 Veneziana, Venice-Mestre, Italy
| | - Paolo Fontana
- Thoracic Surgery Unit, ULSS 12 Veneziana, Venice-Mestre, Italy
| | | | - Giacomo Leoncini
- Thoracic Surgery Unit, IRCCS Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Marco Alloisio
- Thoracic Surgery Unit, Humanitas Research Hospital, Rozzano, Italy
| | - Maurizio Infante
- Thoracic Surgery Unit, Humanitas Research Hospital, Rozzano, Italy
| | - Luca Luzzi
- Thoracic Surgery Unit, University of Siena, Siena, Italy
| | - Piero Paladini
- Thoracic Surgery Unit, University of Siena, Siena, Italy
| | - Alberto Oliaro
- Thoracic Surgery Unit, University of Torino, Torino, Italy
| | - Enrico Ruffini
- Thoracic Surgery Unit, University of Torino, Torino, Italy
| | | | | | | | - Monica Casiraghi
- Thoracic Surgery Unit, European Institute of Oncology, Milan, Italy
| | - Michele Rusca
- Thoracic Surgery Unit, University of Parma, Parma, Italy
| | | | - Luca Ampollini
- Thoracic Surgery Unit, University of Parma, Parma, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Leuzzi
- Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Felice Mucilli
- Thoracic Surgery Unit, University of Chieti, Pescara, Italy
| | | | | | | | - Federico Rea
- Thoracic Surgery Unit, University of Padova, Padova, Italy
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Burt BM, Richards WG, Lee HS, Bartel S, Dasilva MC, Gill RR, Jaklitsch MT, Johnson BE, Swanson SJ, Bueno R, Sugarbaker DJ. A Phase I Trial of Surgical Resection and Intraoperative Hyperthermic Cisplatin and Gemcitabine for Pleural Mesothelioma. J Thorac Oncol 2018; 13:1400-1409. [PMID: 29753120 DOI: 10.1016/j.jtho.2018.04.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/11/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022]
Abstract
INTRODUCTION The primary objective of this single-institution phase I clinical trial was to establish the maximum tolerated dose of gemcitabine added to cisplatin and delivered as heated intraoperative chemotherapy after resection of malignant pleural mesothelioma. METHODS The extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) treatment arms were based on investigators' assessment of patient fitness and potential for macroscopic complete resection. Previously established intracavitary dosing of cisplatin (range 175-225 mg/m2) with systemic cytoprotection was used in combination with escalating doses of gemcitabine, following a 3-plus-3 design from 100 mg/m2 in 100-mg increments. RESULTS From 2007 to 2011, 141 patients were enrolled and 104 completed treatment. The median age of those completing treatment was 65 years (range 43-85 years), and 22 (21%) were female. In the EPP arm (n = 59), 31 patients (53%) had the epithelioid histologic type and the median radiographic tumor volume was 236 cm3 (range 16-4285 cm3). In the P/D arm (n = 41), 29 patients (71%) had the epithelioid histologic type and the median tumor volume was 79 cm3 (range 6-1107 cm3). The operative mortality rate was 2%, and 35 and 22 serious adverse events were encountered among 27 patients (46%) and 16 patients (39%) in the EPP and P/D arms, respectively. Dose-limiting toxicity (grade 3 leukopenia) was observed in two patients who were receiving 1100 mg/m2 of gemcitabine, thus establishing the maximum tolerated dose at 1000 mg/m2, in combination with 175 mg/m2 of cisplatin. The median overall and recurrence-free survival times in treated patients were 20.3 and 10.7 months, respectively. CONCLUSIONS Combination cisplatin and gemcitabine heated intraoperative chemotherapy can be administered safely and feasibly in the context of complete surgical resection of malignant pleural mesothelioma by EPP or P/D.
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Affiliation(s)
- Bryan M Burt
- Department of Surgery, Division of General Thoracic Surgery, Baylor College of Medicine, Houston, Texas
| | - William G Richards
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hyun-Sung Lee
- Department of Surgery, Division of General Thoracic Surgery, Baylor College of Medicine, Houston, Texas
| | - Sylvia Bartel
- Research Pharmacy Core, Pharmacy and Clinical Support, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Marcelo C Dasilva
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ritu R Gill
- Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael T Jaklitsch
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Bruce E Johnson
- Cancer Center, Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Scott J Swanson
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Raphael Bueno
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - David J Sugarbaker
- Department of Surgery, Division of General Thoracic Surgery, Baylor College of Medicine, Houston, Texas.
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Waller DA. The management of malignant pleural mesothelioma in the USA 2004-13-a decade of lost opportunity? J Thorac Dis 2018; 10:S1044-S1046. [PMID: 29849196 PMCID: PMC5949425 DOI: 10.21037/jtd.2018.04.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 12/13/2022]
Affiliation(s)
- David A Waller
- Department of Thoracic Surgery, St Bartholomew's Hospital, London, UK
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42
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Bölükbas S, Eberlein M. Treatment of malignant pleural mesothelioma: lessons learned and quo vadis? J Thorac Dis 2018; 10:1183-1185. [PMID: 29708117 DOI: 10.21037/jtd.2018.01.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Servet Bölükbas
- Department of Thoracic Surgery, Kliniken Essen-Mitte, Evang. Huyssens-Stiftung/Knappschafts-Krankenhaus, Essen, Germany
| | - Michael Eberlein
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Abstract
Pleural metastasis is a common occurrence in up to 30% of patients with metastatic cancer. When lung entrapment and loculation of fluid occur, treatment is more difficult and we have named this condition "oncothorax." The malignant adhesions that entrap the lung in an oncothorax are not typically amenable to surgical decortication. The standard approach for managing these patients is to place an indwelling catheter. Other options may include pleurectomy and decortication, intrapleural hyperthermic chemoperfusion, and intrapleural photodynamic therapy. However, these procedures should be provided selectively depending on patient performance status, extent of metastatic disease, and level of experience.
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Affiliation(s)
- Roman Petrov
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital, Fox Chase Cancer Center, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Charles Bakhos
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital, Fox Chase Cancer Center, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Abbas E Abbas
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital, Fox Chase Cancer Center, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA.
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Kindler HL, Ismaila N, Armato SG, Bueno R, Hesdorffer M, Jahan T, Jones CM, Miettinen M, Pass H, Rimner A, Rusch V, Sterman D, Thomas A, Hassan R. Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2018; 36:1343-1373. [PMID: 29346042 DOI: 10.1200/jco.2017.76.6394] [Citation(s) in RCA: 262] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To provide evidence-based recommendations to practicing physicians and others on the management of malignant pleural mesothelioma. Methods ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, pathology, imaging, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2017. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. Results The literature search identified 222 relevant studies to inform the evidence base for this guideline. Recommendations Evidence-based recommendations were developed for diagnosis, staging, chemotherapy, surgical cytoreduction, radiation therapy, and multimodality therapy in patients with malignant pleural mesothelioma. Additional information is available at www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Hedy L Kindler
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nofisat Ismaila
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel G Armato
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raphael Bueno
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary Hesdorffer
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thierry Jahan
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Clyde Michael Jones
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Markku Miettinen
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Harvey Pass
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andreas Rimner
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie Rusch
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel Sterman
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anish Thomas
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raffit Hassan
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
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45
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Taioli E, van Gerwen M, Mihalopoulos M, Moskowitz G, Liu B, Flores R. Review of malignant pleural mesothelioma survival after talc pleurodesis or surgery. J Thorac Dis 2017; 9:5423-5433. [PMID: 29312753 DOI: 10.21037/jtd.2017.11.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive tumor and the prognosis is still dismal despite the various proposed multimodal treatment plans. Currently, new palliative treatments, such as talc pleurodesis, are being explored besides traditional surgery. This review reports survival rates after talc pleurodesis in comparison to surgery in patients with malignant pleural mesothelioma. A systematic literature search yielded 49 articles eligible for this review. The mean survival in the talc pleurodesis group was 14 months compared to 17 and 24 months for the pleurectomy decortication (P/D) group and extrapleural pneumonectomy (EPP) group, respectively. Few studies reported on the 1-, 2-year overall survival for the talc pleurodesis group and the results were very heterogeneous. The pooled 1-year overall survival for the P/D and EPP groups were 55% [credibility limits (CL): 21-87%] and 67% (CL: 3-89%), the pooled 2-year overall survival were 32% (CL: 8-63%) and 36% (CL: 8-54%), respectively. The pooled 1- and 2-year survival for surgery independently from the type of surgery were 62% (CL: 38-84%) and 34% (CL: 16-54%). There was significant heterogeneity in all the analyses. This review shows that there is limited research on the survival rate after talc pleurodesis compared to surgery in the treatment of malignant pleural mesothelioma. A comparison study is necessary to accurately assess the best way to treat MPM patients, including assessment of the quality of life after treatment as an outcome measure.
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Affiliation(s)
- Emanuela Taioli
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maaike van Gerwen
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meredith Mihalopoulos
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gil Moskowitz
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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46
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Mohapatra PP, Chiemezie CO, Kligman A, Kim MM, Busch TM, Zhu TC, Greer A. 31 P NMR Evidence for Peroxide Intermediates in Lipid Emulsion Photooxidations: Phosphine Substituent Effects in Trapping. Photochem Photobiol 2017; 93:1430-1438. [PMID: 28722754 DOI: 10.1111/php.12810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/26/2017] [Indexed: 01/05/2023]
Abstract
Intralipid is a lipid emulsion used in photodynamic therapy (PDT) for its light scattering and tissue-simulating properties. The purpose of this study is to determine whether or not Intralipid undergoes photooxidation, and we have carried out an Intralipid peroxide trapping study using a series of phosphines [2'-dicyclohexylphosphino-2,6-dimethoxy-1,1'-biphenyl-3-sulfonate, 3-(diphenylphosphino)benzenesulfonate, triphenylphosphine-3,3',3''-trisulfonate and triphenylphosphine]. Our new findings are as follows: (1) An oxygen atom is transferred from Intralipid peroxide to the phosphine traps in the dark, after the photooxidation of Intralipid. 3-(Diphenylphosphino)benzenesulfonate is the most suitable trap in the series owing to a balance of nucleophilicity and water solubility. (2) Phosphine trapping and monitoring by 31 P NMR are effective in quantifying the peroxides in H2 O. An advantage of the technique is that peroxides are detected in H2 O; deuterated NMR solvents are not required. (3) The percent yield of the peroxides increased linearly with the increase in fluence from 45 to 180 J cm-2 based on our trapping experiments. (4) The photooxidation yields quantitated by the phosphines and 31 P NMR are supported by the direct 1 H NMR detection using deuterated NMR solvents. These data provide the first steps in the development of Intralipid peroxide quantitation after PDT using phosphine trapping and 31 P NMR spectroscopy.
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Affiliation(s)
| | - Callistus O Chiemezie
- Department of Chemistry, Brooklyn College, Brooklyn, NY
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, New York, NY
| | - Arina Kligman
- Department of Chemistry, Brooklyn College, Brooklyn, NY
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, New York, NY
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA
| | - Alexander Greer
- Department of Chemistry, Brooklyn College, Brooklyn, NY
- Ph.D. Program in Chemistry, The Graduate Center of the City University of New York, New York, NY
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47
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Browning RJ, Reardon PJT, Parhizkar M, Pedley RB, Edirisinghe M, Knowles JC, Stride E. Drug Delivery Strategies for Platinum-Based Chemotherapy. ACS NANO 2017; 11:8560-8578. [PMID: 28829568 DOI: 10.1021/acsnano.7b04092] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Few chemotherapeutics have had such an impact on cancer management as cis-diamminedichloridoplatinum(II) (CDDP), also known as cisplatin. The first member of the platinum-based drug family, CDDP's potent toxicity in disrupting DNA replication has led to its widespread use in multidrug therapies, with particular benefit in patients with testicular cancers. However, CDDP also produces significant side effects that limit the maximum systemic dose. Various strategies have been developed to address this challenge including encapsulation within micro- or nanocarriers and the use of external stimuli such as ultrasound to promote uptake and release. The aim of this review is to look at these strategies and recent scientific and clinical developments.
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Affiliation(s)
- Richard J Browning
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford , Oxford OX1 2JD, United Kingdom
| | | | | | | | | | - Jonathan C Knowles
- Department of Nanobiomedical Science and BK21 Plus NBM, Global Research Center for Regenerative Medicine, Dankook University , 518-10 Anseo-dong, Dongnam-gu, Cheonan, Chungcheongnam-do, Republic of Korea
- The Discoveries Centre for Regenerative and Precision Medicine, UCL Campus , Gower Street, London WC1E 6BT, United Kingdom
| | - Eleanor Stride
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford , Oxford OX1 2JD, United Kingdom
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48
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Friedberg JS. Reply. Ann Thorac Surg 2017; 104:1434-1435. [PMID: 28935311 DOI: 10.1016/j.athoracsur.2017.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Joseph S Friedberg
- Division of Thoracic Surgery, University of Maryland, 29 S Greene St, Baltimore, MD 21201.
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49
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Diode-Pumped Laser for Lung-Sparing Surgical Treatment of Malignant Pleural Mesothelioma. Ann Thorac Surg 2017; 103:e529-e530. [PMID: 28528059 DOI: 10.1016/j.athoracsur.2017.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/20/2016] [Accepted: 01/01/2017] [Indexed: 11/20/2022]
Abstract
Surgical resection represents one of the essential cornerstones in multimodal treatment of malignant pleural mesothelioma. In cases of tumor infiltration of the lung, lung-scarifying procedures such as lobectomies or pneumonectomies might be necessary to achieve macroscopic complete resection. However, this increases the morbidity of the patients because it leads to possible delay of the planned chemotherapy or radiotherapy. Innovative surgical techniques are therefore required to enable salvage of the lung parenchyma and optimization of surgical treatment. Here we report our first experience with a diode-pumped neodymium-doped yttrium aluminium garnet laser for parenchyma-sparing lung resection during surgery for malignant pleural mesothelioma.
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50
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Chan WH, Sugarbaker DJ, Burt BM. Intraoperative adjuncts for malignant pleural mesothelioma. Transl Lung Cancer Res 2017; 6:285-294. [PMID: 28713674 DOI: 10.21037/tlcr.2017.05.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Malignant pleural mesothelioma (MPM) is a rapidly fatal disease. Multimodality surgically based therapies may extend survival in select patients, however, local relapse after resection is common. Novel intraoperative adjunctive therapies including heated intraoperative chemotherapy (HIOC), heated intraoperative povidone-iodine (PVP-I), and photodynamic therapy (PDT) target micrometastatic disease and aim to improve local control. This review details the most recent studies and trials of HIOC, heated intraoperative PVP-I, and PDT, this aims to provide an update on some of the most promising intraoperative adjuncts for patients with MPM.
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Affiliation(s)
- Warren Ho Chan
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David J Sugarbaker
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bryan M Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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