The Experience on PDT by the Multidisciplinary Group in Padova

Abstract

We present our experience on lung and esophageal cancers treated by PDT. Since 1982, we have been using PDT in carcinomas of the head and neck, recurrences of gynecological tumors, skin cancers, and recurrences of brain tumors. We have treated the initial lesions of lung and esophageal cancers. From June 1989 to November 2004, 40 patients with 50 NSCLC were treated with PDT. Twelve cases were inoperable for medical reasons and were staged as T1N0M0, and 28 had recurrent in situ carcinoma. Patients with residual disease after PDT received definitive radiotherapy and/or brachytherapy. With PDT there was 72% complete response (CR) rate (36/50 treated lesions); that is, 27 CR among the 37 Tis carcinomas and 9 among the 13 T1 cases. Kaplan-Meier curves showed a mean overall survival (OS) of 75.59 months (median 91.4 months). Two- and 5-year OS rates were 72.78% and 59.55%, respectively. The mean and median survival rates for patients with Tis stage were 86.5 and 120.4 months, respectively (standard error 9.50), and for patients with T1 disease they were 45.78 and 35.71 months, respectively; the differences were statistically significant (P < 0.03). No severe early or late PDT-related adverse events were recorded. We report the effects of PDT on inoperable early-stage esophageal cancer. Sixty-two patients were treated with an argon dye laser (630-nm wavelength, 300−800 mW of power, energy dose of 200−300 J/cm2) after intravenous injection of 5 mg/kg of hematoporphyrin derivative. Eighteen patients (29.5%) had in situ carcinoma (Tis), 30 (48.5%) had T1-stage cancer, 7 (11%) had T2-stage cancer, and 7 (11%) had recurrent disease in the anastomotic area after previous surgery without evidence of invasion outside the lumen. The complete response (CR) rate was 37% (23 of 62) in patients who received PDT alone and 82% (51 of 62) in those who also received radiotherapy. The CR rate after PDT alone was statistically higher (p < 0.04) for patients who had Tis/T1 lesions (21 of 48; 44%) than for those with T2-stage disease (2 of 7; 28%) or recurrent tumors (0 of 7; 0%). Fifty-two percent of patients who had CR following PDT alone did not suffer local tumor recurrence. The median local progression-free survival times after PDT and additional radiotherapy (in cases with incomplete response) were 49 months for Tis- and T1-stage lesions, 30 months for those with T2-stage disease, and 14 months for patients with locally recurrent disease. Patients who completely responded to PDT had a median overall survival (OS) of 50 months, which was significantly longer (p < 0.003) than that of patients not responding to PDT. Toxicity was minimal; we recorded three cases of esophageal stenosis (7%) and one case of tracheo-esophageal fistula (2.5%) after combined PDT and radiotherapy. In conclusion, PDT is an effective regimen for early esophageal cancer and NSCLC, giving a good CR rate and long-term results with local control and favorable overall survival. Additional radiotherapy in cases of incomplete response to PDT is effective and potentiall...