Is bronchoscopic photodynamic therapy a therapeutic option in lung cancer?

Abstract

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 ...

Place of cryotherapy, brachytherapy and photodynamic therapy in therapeutic bronchoscopy of lung cancers

“…Nevertheless, by virtue of its high incidence, advanced stage of disease at presentation and highly unresectable rate, lung cancer became one of the first cancers to be targeted for PDT trials [82][83][84][85].…”

Photodynamic Therapy for Lung Cancer

“…İleri (N=636 hasta) ve erken (N=517 hasta) evre akciğer kanserli hastalarda FDT etkinliği, mortalite, morbidite, sağ kalım ve semptomatik etkinlik şeklinde değerlendiril-miştir (15). Her iki grupta da işleme ait mortalite saptanmamıştır.…”

“…Her iki grupta semptomatik etkinlik %100 ve ileri evre kanserli hastalarda, performans skalası düşük olanlarda beklendiği gibi 5 yıllık sağ kalım daha düşük saptanmıştır. Erken evre in situ tümörlerde 5 yıllık sağ kalım %90 ve tam remisyon/yanıt hastalarında %70 bulunmuştur (15). FDT komplikasyonları; güneş ışınlarına duyarlılık nedeniyle, 8 hafta içerisinde cilt yanıkları riski, kanama, bronkoplevral fistül (geç doku nekrozu nedeniyle), havayolu obstrüksiyonu (nekrotik tümör, kanama), skar gelişimi ve subepitelyal fibrozisdir.…”

Current endobronchial surgery in multiple primary lung cancer

“…История хирургиче- ского лечения больных двусторонним ПМРЛ посредством опера-тивных вмешательств берет свое начало в середине XX века, когда одновременно или последовательно выполняли операции на обо-их легких. За последние годы отмечена тенденция к уменьшению объема оперативного вмешательства при двустороннем синхрон-ном раке легких за счет использования методов внутрипросвет-ной эндоскопической хирургии и терапии [17][18][19][20][21].…”