Photodynamic Therapy for Patients With Endobronchial Carcinoid

Abstract

PURPOSE: Photodynamic therapy (PDT) has been used successfully in patients with endobronchial non-small cell lung cancer (NSCLC) with curative and palliative intent. We assessed outcomes of PDT in patients with endobronchial carcinoid. METHODS: This is a records review using a multi-center registry that consists of patients who received endobronchial PDT for curative intent or for management of pulmonary symptoms. We evaluated adverse events and clinical outcomes including survival. All patients received porfimer sodium at 1-2 mg/kg intravenously as the photosensitizer. Light was administered at 630 nm for a total dose of 200 J, except for one case as noted below. RESULTS: 1998 and 2014, 893 patients were treated with 1061 courses of PDT for esophageal and lung malignancies at 5 centers. Endobronchial PDT accounted for 530 of the cases. 9 patients received PDT for treatment of endobronchial carcinoid. Endobronchial therapy was offered when surgical resection could not be performed. 7/9 patients responded to PDT, and 4/9 exhibited patholocial complete responses with absence of tumor on repeat bronchoscopy. 1 patient with bulky disease at the carina was treated with 500J, responded poorly, and developed tracheoesophageal fistula postoperatively. 1 patient with multifocal disease required short term ventilator support. There were no post procedure deaths. Massive hemoptysis was not observed. CONCLUSIONS: Endobronchial carcinoid can be ablated with PDT. Endobronchial PDT with porfimer sodium is generally welltolerated with minimal morbidity. Significant hemoptysis was not observed even in the setting of multiple endobronchial manipulations of the tumor. Light dosage greater than 200J should be avoided. Tumor response to PDT was seen in 7/9 cases (77%), and this led to a pathological complete response in 4/9 (44%). CLINICAL IMPLICATIONS: Carcinoid tumors are responsive to treatment with PDT. PDT should be considered for endobronchial treatment of carcinoid when surgical resection is not an option.

Photodynamic therapy with cryotherapy for endobronchial typical carcinoid

“…We prefer PDT over other modalities because it provides a predictable penetration depth (4-6 mm in a single direction, up to a 10-12 mm radius), the ability to treat large surfaces, selective tumoricidal action with immunogenic properties and curative potential. 1 , 2 , 3 , 4 …”

“…Photodynamic therapy (PDT) is a seldom-reported application for endobronchial typical carcinoid (TC). 1 , 2 , 3 , 4 Although surgical resection is the mainstay of treatment, some patients may not be candidates or require extensive operations. Consequently, the authors describe their PDT experience in 2 patients ( Video 1 ).…”