Photodynamic therapy adjuvant to surgery in metastatic carcinoma in brain

Cerebral metastases occur in 15-40% of cancers and their incidence is increasing. We have studied the use of fluorescence image-guided surgery and repetitive photodynamic therapy in 14 metastatic brain cancers. Methods: Case note review of prospectively collected data on patients who were treated with PDT at the time of surgery for brain metastases. Patients were consented for the surgery and PDT. Patients were given 2 mg/kg body weight of Photofrin (R) IV 48 h before the surgery and 20 mg/kg 5-aminolevulenic acid orally 3 h before surgery. Following resection of the tumor using fluorescence, microsurgical. and image guidance techniques, the post-excision cavity is filled with a balloon using 0.32% intralipid solution and up to five consecutive PDT treatments were given using 100 J/cm(2) Diode Laser 630 nm. Patients were followed up clinically and by brain imaging every 3 months tilt their death. Results: Seven were tung in origin and seven of variable sources. One patient with tung metastases died of unrelated cause white the remaining six had remained free from brain disease tilt their death. Two of the remaining seven patients died of local brain recurrence, one bowel after 4 weeks and one of unknown primary after 70 weeks. Conclusion: Adjuvant repetitive PDT seems to offer an excellent local control of metastatic brain carcinomas with about 79% of patients succumb to the primary and only two out of fourteen died of brain recurrence with the best results obtained in tung cancer. (C) 2009 Published by Elsevier B.V.