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

Eur J Cardiothorac Surg. 1999 Jan;15(1):1-6. doi: 10.1016/s1010-7940(98)00295-4.

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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

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

Substances

  • Antineoplastic Agents
  • Porphyrins
  • polyhaematoporphyrin
  • Dihematoporphyrin Ether