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.
Highlights
Lung cancer is the leading cause of cancer death in the United States.[1]
The purpose of this study is to summarize our early experience with photodynamic therapy (PDT) in the palliation of symptoms in patients with terminal lung cancer and obstructing endobronchial lesions
PDT was initiated at The University of California, Irvine, Medical Center
Summary
Lung cancer is the leading cause of cancer death in the United States.[1] Recent studies show that as many as 76% of newly diagnosed non–small-cell lung cancer (NSCLC) cases are classified as stage III/IV.[2] most patients have a poor chance of receiving curative treatment, so therapy is aimed at palliation. Patients often present with significant symptoms of disease at Divisions of Cardiothoracic Surgery and Pulmonary/Critical Care Medicine, The University of California, Irvine, Medical Center, Orange, California. Regardless of presentation or condition, stage III/IV lung cancer patients face significant morbidity, reduction in quality of life, and certain mortality.[6,7] Physicians and patients are left with few options for definitive treatment and/or palliation. Chemotherapy, radiation, and neodymium:yttrium-aluminumgarnet (Nd-YAG) laser treatment are all available for tumor containment, debulking, and slowing of disease progression.[8,9,10,11] Surgical excision has not been proven to significantly extend survival for such patients.[12,13]
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