Study Objectives: To review the Yorkshire Laser Centre experience concerned with bronchoscopic photodynamic therapy (PDT) in early central lung cancer in subjects not eligible for surgical operation and to discuss diagnostic problems and the indications for PDT in such cases.
Subjects and methods: Amongst 200 patients undergoing bronchoscopic PDT, 21 had early central lung cancer and were entered into a prospective study. Patients had standard work up including white light bronchoscopy in all and autofluorescence bronchoscopy in 12 of the most recent cases. Indications for bronchoscopic PDT were recurrence/metachronous endobronchial lesions following previous treatment with curative intent in 10 patients (11 lesions), ineligibility for surgery because of poor cardio- respiratory function in 8 patients (9 lesions) and declining consent to operation in 3 patients respectively. PDT method consisted of intravenous administration of Photofrin 2 mg/kg bw followed by bronchoscopic illumination 24-48 hours later.
Results: 29 treatments were carried out in 21 patients (23 lesions). There was no procedure-related or 30 day mortality. One patient developed mild skin- photosensitivity. All patients expressed satisfaction to treatment and had complete response for variable duration. Six patients died from 3-103 months (mean 39.3), 3 not in consequence of cancer. 15 patients are alive from 12-82 months.
Conclusion: Bronchoscopic PDT in early central lung cancer can achieve long disease-free survival and should be considered as a treatment option in those ineligible for resection. Autofluorescence bronchoscopy is a valuable complimentary investigation in such cases, for diagnosis identification of synchronous lesions and accurate illumination in bronchoscopic PDT.
- Bronchoscopic Photodynamic Therapy
- Early Lung Cancer
- Fluorescence Bronchoscopy