Role of bronchoscopic photodynamic therapy in lung cancer management

At present there is universal awareness of the role of photodynamic therapy in oncology. There is also a widespread acceptance of its safety and efficacy in its bronchoscopic application for bronchopulmonary malignant neoplasia. It, is therefore, both timely and relevant to present here the current status of bronchoscopic photodynamic therapy in lung cancer based on a critical review highlighting its indications and results.

Bronchoscopic photodynamic therapy has emerged as an important treatment in lung cancer. In advanced disease with focus on quality of life, it offers palliation to all patients and survival benefit to a defined subset. In early cases it provides long survival (potential cure). In patients with intraepithelial stage disease, when it can be accurately diagnosed by the use of fluorescence bronchoscopy and endoscopic ultrasonography, the results can match those of surgical resection.

In bronchoscopic photodynamic therapy, the endobronchial tumor is presensitized by systemic administration of a sensitizing photochemical. After a time interval, bronchoscopic illumination (exposure to laser light) is performed to achieve cancer necrosis. The prerequisite for bronchoscopic photodynamic therapy is identification and histologic evidence of cancer within the airway. Photodynamic therapy is indicated in both early and advanced stage cancer. In patients with advanced disease and important exophytic tumors, the aim is palliation; in those with early central disease, treatment is done with curative intent. A large body of published evidence now suggests that these objectives are achievable.