Intraoperative Meso-Tetrahydroxyphenylchlorin-Based Photodynamic Therapy in Metastatic Gynecologic Cancer Tissue: Initial Results

Abstract

ABSTRACT

We conducted a phase I study to investigate the efficacy and the side effects of intraoperative meso-tetrahydroxyphenylchlorin-based photodynamic therapy (m-THPC-PDT) to treat recurrent gynecologic malignancies. Our initial results are based on 8 patients afflicted with terminal disease. Four patients with previously treated ovarian tumors and 2 patients with previously treated uterine tumors underwent debulking surgery of metastatic secondary tumors per laparotomy. This was combined with intraoperative PDT of the resected areas or peritoneum or both to treat for histologically verified residual nodular metastases. Two additional patients with ovarian cancer relapses who had pertioneal carcinomatosis were treated with PDT solely by laparoscopy. All patients had been previously treated maximally with conventional methods. The photosensitizer m-THPC was applied (0.15 mg/kg body weight) intravenously (i.v.) 96 h preoperatively. Activation of the photosensitizer was accomplished with a KTP:YAG-pumped dye laser (λ = 652 nm) delivering 5 J/cm². The prephototherapeutic intraoperative concentration ratio of tumor/fatty tissue was 4.5. Clinically, 7 of 8 patients either improved or showed no change as indicated by preoperative and postoperative use of the Karnofsky index. Cardiac insufficiency coupled with multiple organ failure caused postoperative mortality in 1 patient shortly after being entered into the study. A second patient succumbed to ileus following intraperitoneal (i.p.) lavage after a 28-month post-PDT survival period. To date, 6 patients remain free of relapse. Our initial results indicate that m-THPC-PDT is a tolerable treatment with limited side effects and can extend survival time without sacrificing quality of life for patients with recurrent gynecologic malignancies. (J GYNECOL SURG 13:23, 1997)