Photodynamic Therapy in the Palliation of Late Stage Obstructing Non-Small Cell Lung Cancer

LoCicero, Joseph; Metzdorff, Mark T.; Almgren, Carol

doi:10.1378/chest.98.1.97

Cited by 66 publications

(20 citation statements)

References 16 publications

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“…205 PDT for lung cancer is particularly useful for (i) patients with advanced disease where PDT is used as a palliation strategy 206-208 and (ii) patients with early central lung cancer when patients are unable to undergo surgery. 209-210 PDT is considered to be more specific and lesion-oriented compared to other available modalities, produces less collateral damage and therefore fewer complications.…”

Section: Clinical Pdtmentioning

confidence: 99%

Photodynamic therapy of cancer: An update

Agostinis

Berg

Cengel

et al. 2011

CA: A Cancer Journal for Clinicians

4,243

3,792

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Photodynamic therapy (PDT) is a clinically approved, minimally invasive therapeutic procedure that can exert a selective cytotoxic activity toward malignant cells. The procedure involves administration of a photosensitizing agent followed by irradiation at a wavelength corresponding to an absorbance band of the sensitizer. In the presence of oxygen, a series of events lead to direct tumor cell death, damage to the microvasculature and induction of a local inflammatory reaction. Clinical studies revealed that PDT can be curative particularly in early-stage tumors. It can prolong survival in inoperable cancers and significantly improve quality of life. Minimal normal tissue toxicity, negligible systemic effects, greatly reduced long-term morbidity, lack of intrinsic or acquired resistance mechanisms, and excellent cosmetic as well as organ function-sparing effects of this treatment make it a valuable therapeutic option for combination treatments. With a number of recent technological improvements, PDT has the potential to become integrated into the mainstream of cancer treatment.

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Section: Clinical Pdtmentioning

confidence: 99%

Photodynamic therapy of cancer: An update

Agostinis

Berg

Cengel

et al. 2011

CA: A Cancer Journal for Clinicians

4,243

3,792

View full text Add to dashboard Cite

show abstract

“…In one study six of the patients with very advanced disease were submitted to EBR following PDT [7]. Of these patients, three developed significant respiratory problems during and following radiation.…”

Section: Group 1: Patients With Advanced Diseasementioning

confidence: 99%

Is bronchoscopic photodynamic therapy a therapeutic option in lung cancer?

Moghissi¹,

Dixon²

2003

Eur Respir J

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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 ...

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“…The photosensitizing agent is selectively retained in the cells and interstitial tissue of the tumour and together with argon dye laser photoradiation generates excited singlet oxygen, which produces a series of structural changes resulting in the destruction of the irradiated tissue [10, 12]. Although a promising use of PDT appears to be in the treatment of early‐stage lung cancer in carefully selected patients [13–17] PDT has been shown also to have a role in the palliation of advanced inoperable obstructive bronchial tumours [4, 18–20]. The aim of this study was to compare the effectiveness and safety of Nd‐YAG laser resection and PDT using DHE as photosensitizer and argon dye laser radiation at 630 nm wavelength in the treatment of partially or totally obstructive tumours in patients with inoperable non‐small cell carcinoma.…”

mentioning

confidence: 99%

Efficacy and safety of photodynamic therapy versus Nd‐YAG laser resection in NSCLC with airway obstruction

Díaz-Jiménez¹,

Martínez-Ballarín²,

Llunell³

et al. 1999

Eur Respir J

117

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A prospective controlled randomized trial was performed in order to assess the effectiveness and safety of photodynamic therapy versus laser resection in 31 patients with partial or complete tracheobronchial obstruction due to inoperable non‐small cell lung cancer. Fourteen patients received dihaematoporphyrin ether and argon dye laser photoradiation, and 17 patients received Nd‐YAG laser resection. Endoluminal obstruction of >75% was found in 77.4% of the patients. Among the symptoms, cough was more severe in the Nd‐YAG group (p=0.02). Patients in both groups experienced symptomatic relief after treatment (p=0.003). Patients in the photodynamic therapy (PDT) group showed a significantly longer time until treatment failure (p=0.03) and longer median survival (p=0.007). Bronchitis and photosensitization (both in the PDT group) were the most common adverse effects. There was one death, probably related to treatment, in the PDT group. Photodynamic therapy and neodymium‐yttrium aluminium garnet laser resection showed similar effectiveness and safety in the palliation of symptoms. The more prolonged survival in the photodynamic therapy group may have been due to differences in tumour stage between the groups. The degree of obstruction improved after treatment in both groups. In conclusion, photodynamic therapy is a valid method of palliation in partially or totally obstructing non‐small cell lung carcinoma.

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Photodynamic Therapy in the Palliation of Late Stage Obstructing Non-Small Cell Lung Cancer

Cited by 66 publications

References 16 publications

Photodynamic therapy of cancer: An update

Photodynamic therapy of cancer: An update

Is bronchoscopic photodynamic therapy a therapeutic option in lung cancer?

Efficacy and safety of photodynamic therapy versus Nd‐YAG laser resection in NSCLC with airway obstruction

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