Photoradiation therapy of endobronchial lung cancers employing the photodynamic action of hematoporphvrin derivative

Abstract

Thirty-five patients with tumors within the tracheobronchial tree were treated with photoradiation therapy (PRT) employing the photodynamic action of hematoporphyrin derivative (HPD). An effective protocol has been developed consisting of 3.0 mg/kg HPD given intravenously 72 hours prior to the bronchoscopic illumination of the endobronchial tumor sites with red light (630 nm) from an argon pumped dye laser. Light applicators were developed that provided surface (area) and insertion (volume) illumination of tumor masses. Average light dosages of 100 J/cm2 and 200 J/cm were used for surface and insertion illumination, respectively. Delivery rates were 200 mW/cm2 and 400 mW/cm. There was no immediate visible effect such as coagulation or charring noted. All malignant endobronchial tumors responded. Tumors included primary and metastatic lesions of various histologic types. Response was complete for tumor within the bronchus after one treatment in 80% of instances. The remaining cases required two treatments to obtain a complete response due to the extensive length of bronchus involved or because multiple sites were present. A complete response, that is, the full opening up of the lumen to the bronchial wall, was accomplished in all but one instance. Atelectatic lungs or lobes were re-expanded and reaerated. Dyspnea and cough became significantly less. The follow-up achieved to date indicates improvement in symptoms, activity level, and the return to work in a significant number of cases.

The effect of aminolaevulinic acid-induced, protoporphyrin IX-mediated photodynamic therapy on the cremaster muscle microcirculation in vivo

“…PDT using the photosensitiser haematoporphyrin derivative (HPD) has been shown to be effective in the treatment of cancers in various sites including skin (Dougherty, 1987), bronchus (Balchum, 1984) and bladder (Nseyo, 1992), often after more conventional treatments have failed. The cytoxicity of HPDmediated PDT has been attributed to the production of reactive oxygen species, although the precise mechanism of damage is not clear.…”

Is bronchoscopic photodynamic therapy a therapeutic option in lung cancer?

“…The earliest article that qualified for inclusion was published in 1984 [3] and the latest was dated 2003.…”

“…Long-term (5-yr) survival amongst patients with TIS and stage 1, who responded fully to treatment, has beeny70% [2]. When death from causes other than cancer was eliminated 5-yr survival of 90% was recorded in treatment of TIS tumours [2]; 4) PDT in bronchial stump recurrence of cancer was reported in three series [2,3,15]. LAM [13] found that three of the five patients with recurrence of cancer at the bronchial stump who initially responded to PDT had tumour recurrence.…”

Place of cryotherapy, brachytherapy and photodynamic therapy in therapeutic bronchoscopy of lung cancers

“…Nevertheless, by virtue of its high incidence, advanced stage of disease at presentation and highly unresectable rate, lung cancer became one of the first cancers to be targeted for PDT trials [82][83][84][85].…”

“…18). The initial trial of bronchoscopic PDT in the 1980s was directed towards symptomatic patients with endoluminal exophytic tumours causing major obstruction [83]. In the light of subsequent and more recent experience, PDT indications in this group have become more stringent.…”