Technique of photodynamic therapy for disseminated intraperitoneal malignant neoplasms. Phase I study
W. F. Sindelar, T. F. DeLaney, Z. Tochner, G. F. Thomas, L. J. Dachoswki, P. D. Smith, W. S. Friauf, J. W. Cole and E. Glatstein
Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892.
Patients with disseminated intraperitoneal malignant neoplasms were given
intra-abdominal photodynamic therapy. Patients received dihematoporphyrin
ethers intravenously 48 to 72 hours before laparotomy at doses of 1.5 to
3.0 mg/kg. At operation, as much tumor as possible was resected. Red light
(630 nm) was delivered to all peritoneal surfaces from an argon-pumped dye
laser at doses ranging from 0.2 to 3.0 J/cm2 in an escalating fashion.
Viscera and peritoneal surfaces were anatomically isolated and exposed to
light for intervals calculated to deliver the prescribed energy. Light was
delivered to mesentery and bowel by a flat-cut optical fiber, while other
areas, including diaphragm, viscera, omental bursa, gutters, and pelvis,
were delivered light through a diffusing wand. Twenty-three patients (13
with ovarian cancer, eight with sarcoma, and two with pseudomyxoma
peritoneii) underwent photodynamic therapy. Five of eight patients cleared
positive peritoneal cytologies after treatment. Six patients remained
clinically free of disease for up to 18 months, and five patients had
treatment-related complications. Intraperitoneal phototherapy is
technically feasible and deserving of clinical evaluation.
