The place of bronchoscopic photodynamic therapy in advanced unresectable lung cancer: experience of 100 cases.

Abstract

OBJECTIVES:

The objectives of the study were: (1) to evaluate effectiveness of photodynamic therapy (PDT) for symptom palliation in patients with inoperable lung cancer; (2) to determine survival benefit in a subset of patients.

METHODS:

One hundred patients, 68 male, 32 female, aged 44-81 years (mean 62.5) with advanced inoperable bronchogenic cancer and endobronchial luminal obstruction were prospectively studied. Eighty-two percent had previous chemo/radiotherapy. The pre-treatment protocol consisted of: clinical, radiological and bronchoscopic examination, pulmonary function testing, assessment of WHO performance status and clinical staging. Treatment protocol was: intravenous injection of 2 mg/kg body weight of photofrin/polyhaematoporphyrin and interstitial illumination using 630 nm laser light 24-72 h later. Follow-up was at 6-8 weeks for 1 year. Then every 3-6 months if applicable. Repeat PDT as necessary.

RESULTS:

All patients were stage IIIa-IV. The histology of the tumour was: non small cell in 90 and small cell in 10. There was no treatment related mortality. Mean endoluminal obstruction fell from 85.8% to 17.5%, mean forced vital capacity (FVC) and forced expiratory volume in 1s (FEVI) improvement was 430 ml and 280 ml, respectively. Ninety patients died from 6 weeks to 37 months, mean and median survival: 9 months and 5 months, respectively. Ten patients are alive from 13 to 72 months, mean 36 months, median 29 months. Overall 2-year survival was 19%. Multivariant analysis indicated that age, sex, histology and stage of disease did not influence survival significantly but performance status did. Patients with WHO < 2 had mean and median survival of 17.8 and 14 months versus WHO > 2, 6.9 mean and 4 months median survival (log-rank P < 0.0001).

CONCLUSIONS:

(1) PDT is effective in palliation of inoperable advanced lung cancer. (2) Subset of patients with a better performance status have added survival benefit.

• Authors: K Moghissi, K Dixon, M Stringer, T Freeman, A Thorpe, S Brown
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 15 Issue 1 Pg. 1-6 (Jan 1999) ISSN: 1010-7940 [Print] Germany
• PMID: 10077365 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents
• Porphyrins
• polyhaematoporphyrin
• Dihematoporphyrin Ether

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (administration & dosage, therapeutic use)
• Biopsy
• Bronchoscopy
• Carcinoma, Bronchogenic (diagnosis, drug therapy, mortality)
• Dihematoporphyrin Ether (administration & dosage, therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Injections, Intravenous
• Laser Therapy
• Lung Neoplasms (diagnosis, drug therapy, mortality)
• Male
• Middle Aged
• Palliative Care
• Photochemotherapy (methods)
• Porphyrins (administration & dosage, therapeutic use)
• Prospective Studies
• Safety
• Survival Rate
• Tomography, X-Ray Computed
• Treatment Outcome