Photodynamic therapy in the palliation of late stage obstructing non-small cell lung cancer

Photodynamic therapy selectively destroys malignant tumors by laser activation of injected hematoporphyrin derivative. Between July 1985 and January 1989, ten patients underwent 13 courses of PDT for relief of endobronchial tumor obstruction due to endstage primary non-small lung cancer. Initial biopsy specimens demonstrated squamous carcinoma in eight patients and adenocarcinoma in two. At the time of treatment, all patients were considered surgically unresectable: T4N2M1(one), T4N2M0(one), T3N3M1(two), T3N2M0(five), and T2N1M0(one). This latter patient had exclusionary medical conditions. The average Karnofsky status was 75 (worst was 60, best was 90). Obstruction was mainstem for six, bronchus intermedius in one, and left upper lobe in three. The average obstruction was 86 +/- 2 percent. Following treatment, the average obstruction was 57 +/- 3 percent. Responses were greater than 50 percent reduction in four and less than 50 percent in six. Half of the patients still had more than 70 percent obstruction following PDT. However, all patients had a decrease in symptoms, especially coughing. Six of ten patients subsequently received external beam radiation. Three of these patients developed significant problems during and following radiation. Side effects of HPD were minimal and included burns in two and mild anasarca in one patient. PDT appears to offer palliation of obstructive symptoms in patients with late stage lung cancer. Since life span is so short in these individuals, physicians must weigh carefully the potential side effects of combination therapy.