Photodynamic therapy (PDT) in early central lung cancer: a treatment option for patients ineligible for surgical resection

Abstract

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.

Outcome of Photodynamic Therapy Using NPe6 for Bronchogenic Carcinomas in Central Airways >1.0 cm in Diameter

“…CLELCs were defined as a lung cancer located no more distally than the segmental bronchi, diagnosed histologically as squamous cell carcinoma, and determined to be carcinoma in situ or carcinoma associated with only limited invasion and no evidence of invasion beyond the bronchial cartilage (18)(19)(20)(21). We routinely determined tumor depth by OCT to confirm that tumors had not invaded the bronchial wall beyond the level of the cartilage and were confined to the basal membrane of the mucosa, submucosa, or intracartilaginous…”

Integration of interventional bronchoscopy in the management of lung cancer

“…Photodynamic therapy (PDT) involves destroying a tumour by activating a photosensitising agent (most commonly a haematoporphyrin derivative) using a light source with a specific wavelength (630 nm), which induces a phototoxic reaction and cell death [7,9,74,75]. The drug is eliminated from most tissues within 72 h, yet remains preferentially stored in the skin, liver, spleen and, above all, in the malignant cells [10].…”

“…A second bronchoscopy must be performed 1-2 days later to remove necrotic tumour tissue and then after 5-7 days to expose residual tissue to a second illumination [40,74,[76][77][78]. PDT is particularly effective in controlling haemoptysis (99%) and dyspnoea, with repermeabilisation and spirometric improvement (a significant improvement of 280 mL and 430 mL for FEV1 and FVC, respectively [76]) obtained in the majority of cases [76,79,80].…”

“…A phototoxic reaction is observed in 5-28% of patients and haemoptysis in 18% (of which 2.2% have been reported as fatal, n=636) [74]. Since the collagen remains unaffected, the risk of perforation is nonexistent [81].…”

Photodynamic Therapy in Combination with Antiangiogenic Approaches Improve Tumor Inhibition

“…PDT can also be repeated without detrimental consequences to the patients. Currently, PDT is being successfully used for the treatment of early lung cancers (Moghissi et al, 2007;Usuda et al, 2006) and in dermatology for the treatment of non-melanoma skin cancers and precancerous diseases (Klein et al, 2008). PDT has also been successfully employed to treat early carcinomas of the oral cavity and larynx to preserve normal tissue and improve cure rates (Biel, 2007).…”