Photodynamic Therapy for Patients with Advanced Non–Small-Cell Carcinoma of the Lung

Abstract

Patients with advanced non-small-cell lung carcinoma (NSCLC) have poor prognoses and experience negative sequelae of disease. Patients often suffer from dyspnea and/or hemoptysis, with overall pulmonary compromise. Patients with advanced, inoperable disease have limited options for treatment. This study summarizes our early experience and findings using photodynamic therapy (PDT) as an effective modality in the palliation of hemoptysis, dyspnea, and physical airway obstruction in cases of inoperable lung cancer. A retrospective review was conducted for the first 10 patients diagnosed with stage III/IV obstructive NSCLC who underwent PDT at our institution. Endobronchial lesions were identified by bronchoscopy. Treatments were initiated 48 hours after intravenous injection of 2 mg/kg of the photosensitizing agent porfimer sodium (Photofrin, QLT PhotoTherapeutics, Vancouver, BC). The porfimer sodium was then activated by illumination with a 630 nm wavelength light using a Coherent argon ion laser through a flexible bronchoscope. Repeated bronchoscopies were performed 1-3 days following initial PDT for evaluation and airway debridement. In 8 cases, a second treatment of PDT was administered within 72 hours of the first injection. One patient received a third treatment several months later. Three patients also received endobronchial stents after PDT. Overall, all 10 patients responded to PDT. Physical airway obstruction was reduced in all patients, with a noted improvement in bronchoscopic luminal diameter. Acute hemoptysis resolved in all 7 symptomatic patients. Median survival was 5.5 months post-PDT, while median survival postdiagnosis was 10.5 months. Three patients are alive at the time of this review at 5-21 months following therapy. Patients with unresectable late-stage NSCLC have few options for treatment. Our early experience with PDT indicates effective relief of hemoptysis, dyspnea, and airway obstruction and improves their quality of life.

Photodynamic Therapy for Lung Cancer and Malignant Pleural Mesothelioma

“…24 In fact, resolution of acute hemoptysis was achieved in 70% of patients treated at the University of California, Irvine with stage III–IV obstructive inoperable NSCLC with hemoptysis, dyspnea, and airway obstruction. 25 Similar excellent control of hemoptysis was achieved with PDT in a prospective study in Austria. 26 …”

Endobronchial photodynamic therapy for lung cancer

“…PDT has been combined in a sequential manner with HDR brachytherapy for palliation of bulky tumor central airway obstruction [29], but HDR brachytherapy has not been compared directly with PDT. When PDT was combined with endobronchial stents in series of 10 patients with lung cancer [30], it resulted in 100% palliation of obstruction, as well as relief of hemoptysis and improvement of dyspnea.…”

Photodynamic Therapy for Lung Cancer: Major Indications

“…Рос-сийские исследователи также показали, что ФДТ позволяет снизить бронхиальную обструкцию в 75 % случаев (9/12) у больных с НМРЛ IIIb-IV стадий и достигнуть 100 % частоты полного от-вета при ранних формах рака легкого (8/8) [26]. Специалистами Калифорнийского университета ответ опухоли после ФДТ также отмечен у всех больных раком легкого III-IV стадий с бронхи-альным стенозом, кроме того, у 7 из 10 больных купировано кровохарканье [27]. Проведение ФДТ позволило исследователям из Алабамы у 74 % больных снизить выраженность одышки, оценен-ной по модифицированной шкале [28].…”