Photodynamic therapy for the treatment of tracheobronchial papillomatosis: A multicenter experience.

Abstract

Recurrent respiratory papillomatosis (RRP) causes mucosal wart-like growths of the upper aerodigestive tract, which can undergo malignant transformation. These tumors are difficult to treat, often requiring repeated debridement, which can be associated with high morbidity. Photodynamic therapy (PDT) uses a photosensitizing medication and a topically applied light source to treat early stage endobronchial lung cancer. Most data on the use of PDT in RRP pertain to laryngeal disease. Our objective was to evaluate the effectiveness of PDT in treating RRP involving the lower respiratory tract. We performed a retrospective multicenter review of adult patients who had a diagnosis of RRP involving the lower airways. We documented details of their disease, treatments, and outcomes. Eight patients underwent PDT for ten RRP lesions. Lesions were located in the trachea and more distal airways. Pathology showed malignant conversion to squamous cell carcinoma in half of the cases. All patient underwent debulking and multimodal treatment concurrently with PDT. Treatment was successful in seven patients with improvement in luminal size. Duration of disease-free recurrence ranged from 4 to 33 months. Five of eight patients have sustained ongoing treatment effect, ranging from 10 to 33 months. Most patient had improved quality of life (83 %) and a reduction in interventions (87 %) after PDT. Complications were minimal. PDT can be a safe and effective tool when treating RRP of the lower respiratory tract, including lesions with malignant transformation. A multimodal treatment approach is associated with improved outcomes. Further prospective studies are needed to fully determine its effectiveness.