Update on the current indications, practice and results of photodynamic therapy (PDT) in early central lung cancer (ECLC)

Abstract

The aim of this study was to investigate the practice and results of photodynamic therapy (PDT) in early central lung cancer (ECLC) based on the review of the literature and personal experience and to suggest the future role of PDT in such patients. Literature search was made for articles on PDT in lung cancer. Only original articles with >10 patients with ECLC treated by PDT were selected. Data collection aimed at providing information on number of patient/lesions in the series, photosensitisers used, illumination method, mortality and morbidity, pathological response to treatment and survival. Fifteen articles (626 patients/715 lesions) were selected. Indication for PDT in the majority had been ineligibility for operation. The drug of choice was Photofrin followed by bronchoscopic illumination using a laser light after an interval of 48-72 h. There was one (0.15%) single death in the whole series. Adverse events consisted mainly of photosensitivity skin reaction (sunburn) 5-28% followed by respiratory complications 0 -18% and non-fatal haemoptysis 0-7.8%. Complete response was recorded in 30-100% for 2-120 months. Five-year survival was 61% (estimated) for those series which have provided the survival data. The analysis highlighted the presence of multifocal lesions in ECLC patients. Currently, the generally accepted indication of PDT in ECLC is for patients ineligible to/or unsuitable for resectional surgery. It achieves a high rate of complete response (CR) and long-term survival. In the future PDT will find its role in patients with ECLC and multifocal lesions.