Survival after photodynamic therapy to non-pulmonary metastatic endobronchial tumors
✍ Scribed by McCaughan, James S.
- Publisher
- John Wiley and Sons
- Year
- 1999
- Tongue
- English
- Weight
- 347 KB
- Volume
- 24
- Category
- Article
- ISSN
- 0196-8092
No coin nor oath required. For personal study only.
✦ Synopsis
Background: For the past 15 years we have used photodynamic therapy (PDT) to treat endobronchial tumors. Unfortunately patients who have non-primary lung cancer metastatic to bronchi and who have failed other treatment regimens may not be offered endobronchial tumor management. Thirteen patients with endobronchial tumors metastatic from non-pulmonary primaries were treated with PDT. We: 1) evaluated the effects of PDT on the tumor, the quality of life, and the length of survival; and 2) compared their survival after PDT to that of 27 patients with stage IV primary endobronchial tumors treated with PDT after they failed all other treatment regimens. Materials and Methods: Photodynamic therapy was performed using 630-nm light delivered through cylinder diffusing tip quartz fibers passed through the biopsy channel of a flexible bronchoscope after intravenous injection of the photosensitizer dihematoporphyrin ether. One to two days after PDT bronchoscopy was repeated and necrotic tissue was mechanically removed and, if necessary, that site or other new sites were treated. Two days after this another bronchoscopy was performed and the necrotic tissue was mechanically removed. Bronchoscopy was repeated one month after PDT and periodically thereafter as needed to re-treat symptomatic residual tumor. The percent obstruction of the bronchus due to tumor was estimated before and at the end of each bronchoscopy. Clinical effects were evaluated using Wilcoxon signed rank tests for scaled parameters of dyspnea, cough, hemoptysis, and Karnofsky Performance Status (KPS) before and one month after PDT. All patients were followed until their death. Results: The mean percent obstruction due to metastatic nonpulmonary tumors at 38 different endobronchial treated sites decreased from 85% to 13% at discharge after PDT. The 72% mean decrease of obstruction was statistically significant using Abbreviations used: CF ס centimeter length of diffuser fiber tip; DHE ס dihematoporphyrin ether; KPS ס Karnofsky Performance Status; J ס Joules; LLL ס left lower lobe bronchus; LMB ס left main bronchus; LUL ס left upper lobe bronchus; mW ס milliwatts; NAP ס not applicable; PDT ס photodynamic therapy; RLL ס right lower lobe bronchus; RMB ס right main bronchus; RML ס right middle lobe bronchus; RUL ס right upper lobe bronchus