(1) PDT is effective in palliation of inoperable advanced lung cancer. (2) Subset of patients with a better performance status have added survival benefit.

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Objectives: To review the Yorkshire Laser Centre experience with bronchoscopic photodynamic therapy (PDT) in early central lung cancer in subjects not eligible for surgery and to discuss diagnostic problems and the indications for PDT in such cases. Methods: Of 200 patients undergoing bronchoscopic PDT, 21 had early central lung cancer and were entered into a prospective study. Patients underwent standard investigations including white light bronchoscopy in all and autofluorescence bronchoscopy in 12 of the most recent cases. Indications for bronchoscopic PDT were recurrence/metachronous endobronchial lesions following previous treatment with curative intent in 10 patients (11 lesions), ineligibility for surgery because of poor cardiorespiratory function in 8 patients (9 lesions) and declined consent to operation in 3 patients. PDT consisted of intravenous administration of Photofrin 2 mg/kg followed by bronchoscopic illumination 24-48 h later. Results: 29 treatments were performed in 21 patients (23 lesions). There was no procedure-related or 30 day mortality. One patient developed mild skin photosensitivity. All patients expressed satisfaction with the treatment and had a complete response of variable duration. Six patients died at 3-103 months (mean 39.3), three of which were not as a result of cancer. Fifteen patients were alive at 12-82 months. Conclusion: Bronchoscopic PDT in early central lung cancer can achieve long disease-free survival and should be considered as a treatment option in those ineligible for resection. Autofluorescence bronchoscopy is a valuable complementary investigation for identification of synchronous lesions and accurate illumination in bronchoscopic PDT.

This study addresses whether photodynamic therapy (PDT) is a valid therapeutic option in lung cancer treatment.A total of 24 articles were reviewed in two categories: advanced (G1) and early (G2) disease. Details considered included the following: 1) number of patients in each series; 2) staging; 3) methodology; 4) mortality; 5) morbidity; 6) survival; 7) relief of symptoms; and 8) concomitant treatments. G1 (636 patients) had severe endobronchial obstructive cancer and PDT was primarily for symptom relief. G2 (517 patients) had early stage cancer and were treated with PDT for curative intent.There was no procedure-related mortality in either group. G1 had a 5-28% incidence of skin sensitivity. Haemoptysis occurred in two series; one fatal, an incidence of 2.2%. Almost all patients had symptomatic relief. Patients with lower disease stage and better performance status had improved survival rates. G2 had a 8-28% incidence of sunburn. Three patients in one series (38 patients) had haemoptysis. Survival after 5 yrs in complete remission/response patients was 70%.This review suggests that bronchoscopic photodynamic therapy has indications in selected lung cancer patients with early or advanced stage disease. However, in the absence of a formal comparative study, no claim can be made of its superiority over other endobronchial therapies. In the case of lung cancer, PDT refers to the endoscopic treatment of tumour, the location and extent of which is first assessed bronchoscopically. A photosensitiser is then administered to the patient by i.v. injection. This is followed, after an interval, by illumination of the presensitised tumour by an appropriate laser light, which is delivered to the target tissue via an optical fibre through the bronchoscope. The light and chemical interaction leads to necrosis of the tumour.Using the above principle, after experimental and preclinical work, KATO [2] used PDT for the first time in 1980 to treat a patient with early lung cancer who refused surgical intervention. Following bronchoscopic PDT, the patient had complete remission (CR) for 4 yrs and died later from a noncancer related cause.The last 20 yrs has seen many publications on PDT for lung cancer showing its therapeutic usefulness in different stages of the disease. In spite of this, in Europe at least, PDT has not become a mainstream lung cancer treatment option even though there is desperate need for newer therapeutic methods other than the traditional trio of surgery, radiotherapy and chemotherapy. It is generally acknowledged that surgical and oncological advances over the past 40-50 yrs have had little impact on either early detection, resection rate or on survival of lung cancer patients.With this background the authors undertook a review of the literature to evaluate the current state of PDT and to discuss the place of PDT for lung cancer treatment within the overall therapeutic options. Material and methodsA literature search was made through Medline (PubMed) for listed articles on PDT in broncho-pulmonary ...

(1) PDT is safe and effective for palliation of dysphagia in inoperable oesophageal cancer. This is particularly important in post-cricoid and cervical oesophageal cancer previously treated by other methods and for patients with recurrent malignant obstruction who previously had intubation or stent placement. (2) Survival is influenced by better PS (< or =2) and in those with disease Stage III rather than patients in Stage IV. This study has not been able to determine the influence of complete tumour staging on survival because, apart from four patients, all others were Stages III and IV cancer.

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