Photodynamic therapy approach for central lung cancer

Abstract

Background: This study aimed to evaluate the efficacy and safety of chlorine series photosensitizer for central lung cancer photodynamic therapy (PDT). Methods: The TMA clinic conducted PDT for 41 patients with central lung cancer. 2 hours before the procedure patients were intravenously injected with chlorine series (Photolon, photoditazin) at a dose of 0.7-1.9 mg / kg. PDT was performed by laser installation with a wavelength corresponding to the absorption spectrum of the photosensitizer, the power supplied doses ranged from 0.4 W to 1.6 W, the laser energy density of 100-300 J/cm 2 . Endoscopic procedures were performed using video system OLYMPUS EVIS Exera 160. For anesthesia local anesthetic lidocaine and general sedation were used. Results: The immediate results were traced in 37 patients. Terms of monitoring of patients ranged from 5 days to 3 years. As an estimate of the treatment effect we used data bronchoscopy, spirometry, radiological picture, as well as the dynamics of patient complaints. During bronchoscopy, at 5-7 days, 8 (21.6%) patients had superficial necrosis of the tumor, in 27 (73%) a deep tumor tissue necrosis, 6 of them showed damage to surrounding healthy tissue, and in 2 patients reaction from the tumor tissue was observed. During bronchoscopy, performed 1 month after PDT, complete tumor regression was observed in 23 (62.2%), partial response -in 12 (32.4%) patients, 2 patients with no revealed tumor shrinkage. If the energy density of the laser radiation (E) is less than 200 J/cm 2 , the frequency marked necrotic changes every 5-7 days after PDT was observed in 5 (45%) of 11 patients after the application dose of 200 or more J/cm 2 at 22 (84.6%) of 26 patients. Similar results were obtained after evaluating the degree of tumor regression 1 month after PDT: complete regression at E, is less than 200 J/cm 2 was achieved in 2 (18.2%) of 11 patients at E greater than or equal to 200 J/cm 2 -at 21 (80.8%) of 26 patients (p < 0.001). Clinically, the implementation effect of photodynamic therapy was shown in the complete cessation of hemoptysis in 75% of patients, reducing cough noted in 55% of patients, reducing breathlessness -47% of patients with these symptoms. Positive dynamics in the form of X-ray resolution of atelectasis and eliminate air disturbances was observed in 84% of cases. Spirometry before and after PDT procedure was conducted in 14 patients with tumor obturation large bronchi. In 4 patients with tumor stenosis of the main bronchus increase in lung capacity after the PDT, procedure ranged from 6 to 33% (on average -20%), 8 patients with bronchial obstruction share -from 3 to 9% (on average 6%). In all patients, administration of a photosensitizer proceed without side reactions, and tolerability of these drugs has been satisfactory. Manifestations of cutaneous phototoxicity, subject to light conditions for 3 days after PDT was observed. The most common complications of PDT procedure are local inflammatory processes. Of the 39 patients observed in 5 developed pneumonia of mild s...