Abstract
BackgroundWe conducted a phase I clinical trial to evaluate the sensitivity, specificity, and safety of cytoreductive surgery (CRS) under aminolevulinic acid-mediated photodynamic diagnosis (ALA-PDD) plus hyperthermic intraperitoneal chemotherapy (HIPEC) on 20 patients with peritoneal carcinomatosis (PC) from ovarian cancer and primary peritoneal carcinoma (PPC).Patients and MethodsPatients took 5-aminolevulinic acid (5-ALA) at a dose of 20 mg/kg orally with 50 mL of water 2 h before surgery. During surgery, the abdominal cavity was observed under blue light (wavelength of 440 nm) before and after CRS plus HIPEC. Specimens were excised and submitted for pathological examination to evaluate the specificity of ALA-PDD. Postoperative course was closely monitored and detailed information was recorded.ResultsCRS under ALA-PDD plus HIPEC was performed 21 times in 20 patients with PC (16 ovarian cancer, 4 PPC) between June 2011 and October 2013. With the exception of 1 (5 %) patient, strong red fluorescence was detected in 19 patients with ovarian cancer, with a sensitivity of 95 %. All specimens from red fluorescent lesions were invaded by cancer cells, with a specificity of 100 %. No severe adverse events occurred during the perioperative period, with the exception of some abnormal laboratory results and mild complications. All patients were alive until the last follow-up.ConclusionALA-PDD provided a high sensitivity and specificity in detecting peritoneal metastasis in patients with PC from ovarian serous carcinoma and PPC. CRS under ALA-PDD plus HIPEC was a feasible and safe treatment option for patients with PC from ovarian cancer and PPC.
Highlights
We conducted a phase I clinical trial to evaluate the sensitivity, specificity, and safety of cytoreductive surgery (CRS) under aminolevulinic acid-mediated photodynamic diagnosis (ALA-PDD) plus hyperthermic intraperitoneal chemotherapy (HIPEC) on 20 patients with peritoneal carcinomatosis (PC) from ovarian cancer and primary peritoneal carcinoma (PPC)
In the second surgery of CRS under ALA-PDD for the patient with ovarian cancer, no specimen was excised since no red fluorescence was detected, and frozen pathological examination showed no malignancy
For the other 40 specimens from the non-fluorescent area, three specimens were tumors, with a false negative rate of 7.5 % (Table 4). This is the first study suggesting that ALA-PDD may be effective in detecting peritoneal metastasis originating from PPC, as well as from ovarian
Summary
CRS under ALA-PDD plus HIPEC was performed 21 times in 20 patients. One patient with ovarian cancer underwent another CRS under ALA-PDD plus HIPEC for a second look 18 months after the first operation. During 20 episodes of initial CRS under ALA-PDD plus HIPEC, peritoneal metastases emitted red fluorescence under irradiation of blue light in 19 patients, with a sensitivity of 95 % (Fig. 1), while peritoneal disseminated gross tumor nodules seen with white light in one (5 %) patient with ovarian cancer did not emit red fluorescence under irradiation of blue light. For the second surgery of the patient with ovarian cancer, no red fluorescence was detected, and no malignancy was found from the results of frozen and final pathological examination. Residual tumor in all patients undergoing incomplete CRS emitted red fluorescence after HIPEC (Fig. 2)
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