Photodynamic therapy and photothermal therapy for the treatment of peritoneal metastasis: a systematic review.

Amandine Pinto,Marc Pocard

doi:10.1515/pp-2018-0124

Abstract

BackgroundThe aim of this review was to analyze preclinical studies and clinical trials evaluating photodynamic therapy (PDT), and photothermal therapy (PTT) in peritoneal metastasis (PM) treatment.ContentSystematic review according PRISMA guidelines. Electronic searches using PubMed and Clinical Trials.SummaryA total of 19 preclinical studies analyzing PDT in PM treatment were included. Each new generations of photosensitizers (PS) permitted to improve tumoral targeting. Phase III preclinical studies showed an important tumoral biodistribution (ratio 9.6 vs normal tissue) and significant survival advantage (35.5 vs 52.5 days for cytoreductive surgery vs cytoreductive surgery+PDT, p<0.005). Height clinical trials showed important side effects (capillary leak syndrome and bowel perforation), mainly explained by low tumor-selectivity of the PS used (first generation mainly).Peritoneal mesothelioma apparition with carbon nanotubes first limited the development of PTT. But gold nanoparticles, with a good tolerance, permitted a limitation of tumoral growth (reduction of bioluminescence to 37 % 20 days after PTT), and survival benefit (35, 32, and 26 days for PTT with cisplatine, PTT alone and laser alone, respectively).OutlookRecent improvement in tumor-selectivity and light delivery systems is promising but further development would be necessary before PDT and PTT routinely applied for peritoneal carcinomatosis.

Highlights

Peritoneal metastasis (PM) is considered as the terminal stage of malignant disease
Outlook: Recent improvement in tumor-selectivity and light delivery systems is promising but further development would be necessary before photodynamic therapy (PDT) and photothermal therapy (PTT) routinely applied for peritoneal carcinomatosis
The adjuvant application of intraperitoneal (IP) chemotherapy could permit the destruction of residual microscopic disease, which is inevitable after cytoreduction surgery (CRS)

Summary

Introduction

Peritoneal metastasis (PM) is considered as the terminal stage of malignant disease. The prognosis is poor with a median survival of approximately 5 months without treatment, and 12–24 months with palliative chemotherapy [1, 2]. The adjuvant application of intraperitoneal (IP) chemotherapy could permit the destruction of residual microscopic disease, which is inevitable after CRS. This treatment presents high mortality rate, about 0–3 % [3, 4], and morbidity rates, about 20–60 % [5]. Two therapeutics are analyzed in PM treatment in this review: photodynamic therapy (PDT), and photothermal therapy (PTT). The aim of this review was to analyze preclinical studies and clinical trials evaluating photodynamic therapy (PDT), and photothermal therapy (PTT) in peritoneal metastasis (PM) treatment. Outlook: Recent improvement in tumor-selectivity and light delivery systems is promising but further development would be necessary before PDT and PTT routinely applied for peritoneal carcinomatosis

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